Clinical and Experimental Hypertension (Apr 2018)

Hemodynamic characterization of hypertensive patients with an exaggerated orthostatic blood pressure variation

  • Jessica Barochiner,
  • Lucas S. Aparicio,
  • José Alfie,
  • Marcelo A. Rada,
  • Margarita S. Morales,
  • Carlos R. Galarza,
  • Paula E. Cuffaro,
  • Marcos J. Marín,
  • Rocío Martínez,
  • Gabriel D. Waisman

DOI
https://doi.org/10.1080/10641963.2017.1368539
Journal volume & issue
Vol. 40, no. 3
pp. 287 – 291

Abstract

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Exaggerated orthostatic blood pressure variation (EOV) is a poorly understood phenomenon related to high cardiovascular risk. We aimed to determine whether hypertensive patients with EOV have a distinct hemodynamic pattern, assessed through impedance cardiography. Methods: In treated hypertensive patients, we measured the cardiac index (CI), systemic vascular resistance index (SVRI), blood pressure (BP), and heart rate (HR) in the supine and standing (after 3 minutes) positions, defining three groups according to BP variation: 1) Normal orthostatic BP variation (NOV): standing systolic BP (stSBP)-supine systolic BP (suSBP) between −20 and 20 mmHg and standing diastolic BP (stDBP)-supine diastolic BP (suDBP) between −10 and 10 mmHg; 2) orthostatic hypotension (OHypo): stSBP-suSBP≤-20 or stDBP-suDBP≤-10 mmHg; 3) orthostatic hypertension (OHyper): stSBP-suSBP≥20 or stDBP-suDBP≥10 mmHg. We performed multivariable analyses to determine the association of hemodynamic variables with EOV. Results: We included 186 patients. Those with OHyper had lower suDBP and higher orthostatic SVRI variation compared to NOV. In multivariable analyses, orthostatic HR variation (OR = 1.06 (95%CI 1.01–1.13), p = 0.03) and orthostatic SVRI variation (OR = 1.16 (95%CI 1.06–1.28), p = 0.002) were independently related to OHyper. No variables were independently associated with OHypo. Conclusion: Patients with OHyper have a distinct hemodynamic pattern, with an exaggerated increase in SVRI and HR when standing.

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