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A recent study published in JAMA Cardiology highlights the critical role of measuring blood pressure (BP) in the supine position to detect hidden cardiovascular risks. Researchers found that supine hypertension—high BP when lying down—is a strong predictor of adverse cardiovascular outcomes, even when seated BP appears normal or is managed with antihypertensive medications.
Key Findings
The prospective analysis leveraged data from the ARIC study, examining 11,369 participants (mean age, 53.9 years; 55.7% women; 74.9% White individuals) over a median follow-up of nearly three decades. The study focused on coronary heart disease, heart failure, stroke, fatal heart disease, and all-cause mortality.
Supine hypertension, defined as a systolic BP ≥ 130 mm Hg or diastolic BP ≥ 80 mm Hg, was linked to:
- A 1.6-fold increased risk of coronary heart disease.
- Over twice the risk of fatal heart disease.
- An 83% higher risk of heart failure.
- An 86% higher risk of stroke.
- A 43% higher risk of all-cause mortality.
These risks were greater than those associated with hypertension in the seated position alone. Notably, individuals with supine hypertension but normal seated BP were at higher risk for cardiovascular disease (CVD) than those with seated hypertension alone.
Clinical Implications
“While hypertension in both seated and supine positions was associated with the highest risk of adverse events, supine hypertension alone emerged as a potent risk factor for CVD,” the study authors wrote.
The findings underscore the simplicity and value of incorporating supine BP measurements into routine clinical practice. Detecting this hidden hypertension could allow for earlier interventions, ultimately reducing the burden of cardiovascular disease.
Study Limitations
The study population skewed younger (under 65), limiting applicability to older adults. The methodology included a 20-minute supine rest period before measurement, which is longer than typical clinic protocols. Additionally, nocturnal BP and temporal variations between BP readings were not accounted for, potentially affecting outcomes.
Funding and Disclosures
This research, led by Duc M. Giao, MD, of Harvard Medical School, was supported by the National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute (NHLBI). Authors disclosed additional grants from various institutes, including the National Institute of Neurological Disorders and Stroke.
Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always consult a healthcare professional for personalized recommendations.
The study emphasizes the importance of revisiting blood pressure measurement practices to better identify at-risk patients and prevent life-threatening cardiovascular events. With hypertension remaining a leading cause of mortality worldwide, this simple change in clinical practice could have significant implications for public health.
