Research progress in diagnosis and treatment and clinical significance
of orthostatic hypertension

doi:10.3760/cma.j.issn.1007-1245.2022.12.006

Abstract

Abstract: Orthostatic hypertension is a neglected but common clinical phenomenon of abnormal blood pressure regulation. Its pathophysiological mechanism is unclear and may be related to autonomic nervous system dysfunction and sympathetic overactivity. A growing number of studies have shown that orthostatic hypertension is associated with hypertension and diabetes mellitus. Treatment of orthostatic hypertension has not been shown to improve outcomes. However, orthostatic hypertension is not a low percentage of the hypertensive population and may be associated with increased cardiovascular risk, so hypertensive patients with or without orthostatic hypertension should be paid attention to. This paper provides the latest researches on the definition, diagnosis, pathophysiological mechanism, clinical significance, and treatment of orthostatic hypertension in recent years to provide new ideas for future research on orthostatic hypertension.

Key words: Orthostatic hypertension, Definition, Pathophysiology, Clinical significance, Treatment, Progress

摘要： 体位性高血压是一种被忽视但常见的血压调节异常的临床现象，其定义缺乏共识，病理生理机制尚不明确，可能与自主神经系统功能障碍、交感神经过度活跃有关。越来越多的证据表明体位性高血压与高血压和糖尿病等相关。目前尚无研究证明治疗体位性高血压可以改善预后，但由于体位性高血压在高血压人群中并不少见，且可能与心血管风险增加有关，因此伴或不伴体位性高血压的患者都应该引起重视。本文就近年来体位性高血压的定义、诊断、病理生理学机制、临床意义及治疗最新研究进行论述，期望可为以后的体位性高血压研究提供新思路。

关键词: 体位性高血压, 定义, 病理生理学, 临床意义, 治疗, 进展

Dong Yumei, Sun Tao, Ma Aiqing, Liang Lei, Zhu Linghua, Zhang Bin. Research progress in diagnosis and treatment and clinical significance of orthostatic hypertension[J]. International Medicine and Health Guidance News, 2022, 28(12): 1650-1655.

董玉梅, 孙涛, 马爱青, 梁磊, 朱凌华, 张彬. 体位性高血压的诊疗及临床意义研究进展[J]. 国际医药卫生导报, 2022, 28(12): 1650-1655.

References

[1] 樊晓寒,吴海英,惠汝太. 体位性低血压与心脑血管疾病[J]. 中华高血压杂志,2009,17(9):858-862. DOI:10.16439/j.cnki.1673-7245.2009.09.019.

[2] Schneider EC, Truesdell D. A statistical study of the pulse rate and the arterial blood pressures in recumbency, standing, and after a standard exercise[J]. Am J Physiol, 1922,61:429-474.

[3] Streeten DH, Auchincloss JH, Anderson GH, et al. Orthostatic hypertension. Pathogenetic studies[J]. Hypertension,1985,7(2):196-203. DOI:10.1161/01.hyp.7.2.196.

[4] Kario K, Eguchi K, Hoshide S, et al. U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor[J]. J Am Coll Cardiol,2002,40(1):133-141. DOI:10.1016/s0735-1097(02)01923-x.

[5] Tabara Y, Igase M, Miki T, et al. Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study[J].Hypertens Res,2016,39(9):664-669. DOI:10.1038/hr.2016.43.

[6] Thomas RJ, Liu K, Jacobs DR, et al. Positional change in blood pressure and 8-year risk of hypertension: the CARDIA Study[J]. Mayo Clin Proc,2003,78(8):951-958. DOI:10.4065/78.8.951.

[7] Finucane C, van Wijnen VK, Fan CW, et al. A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring[J]. Clin Auton Res,2019,29(4):427-441. DOI:10.1007/s10286-019-00606-y.

[8] Townsend RR, Chang TI, Cohen DL, et al. Orthostatic changes in systolic blood pressure among SPRINT participants at baseline[J]. J Am Soc Hypertens,2016,10(11):847-856. DOI:10.1016/j.jash.2016.08.005.

[9] Suemoto CK, Baena CP, Mill JG, et al. Orthostatic hypotension and cognitive function: cross-sectional results from the ELSA-Brasil study[J]. J Gerontol A Biol Sci Med Sci,2019,74(3):358-365. DOI:10.1093/gerona/gly061.

[10] Bhuachalla BN, McGarrigle CA, O'Leary N, et al. Orthostatic hypertension as a risk factor for age-related macular degeneration: evidence from the Irish longitudinal study on ageing[J]. Exp Gerontol,2018,106:80-87. DOI:10.1016/j.exger.2018.02.029.

[11] Yoshinari M, Wakisaka M, Nakamura U, et al. Orthostatic hypertension in patients with type 2 diabetes[J]. Diabetes Care,2001,24(10):1783-1786. DOI:10.2337/diacare.24.10.1783.

[12] Kario K. Orthostatic hypertension-a new haemodynamic cardiovascular risk factor[J].Nat Rev Nephrol,2013,9(12):726-738. DOI:10.1038/nrneph.2013.224.

[13] Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope[J]. Eur Heart J,2018,39(21):1883-1948. DOI:10.1093/eurheartj/ehy037.

[14] Brignole M, Moya A, de Lange FJ, et al. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope[J]. Eur Heart J,2018,39(21):e43-e80. DOI:10.1093/eurheartj/ehy071.

[15] Magkas N, Tsioufis C, Thomopoulos C, et al. Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations[J]. J Clin Hypertens (Greenwich),2019,21(3):426-433. DOI:10. 1111/jch.13491.

[16] Kocyigit SE, Erken N, Dokuzlar O, et al. Postural blood pressure changes in the elderly: orthostatic hypotension and hypertension[J].Blood Press Monit,2020,25(5):267-270. DOI:10.1097/MBP.0000000000000466.

[17] Petersen Á, Salas-Herrera C, Lerma C, et al. Transient orthostatic hypertension during head-up tilt test in young adults: a phenotype of blood pressure variability[J]. J Clin Neurophysiol,2021,38(3):242-249. DOI:10.1097/WNP.0000000000000685.

[18] Hoshide S, Parati G, Matsui Y, et al. Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin[J].Hypertens Res,2012,35(1):100-106. DOI:10.1038/hr.2011.156.

[19] Robertson D. Orthostatic hypertension: the last hemodynamic frontier[J].Hypertension,2011,57(2):158-159. DOI:10.1161/HYPERTENSIONAHA.110.163485.

[20] 陶军,张媛媛. 体位性高血压发生机制与防治[J]. 中国实用内科杂志,2012,32(1):32-35.

[21] 樊晓寒,惠汝太. 体位性高血压[J]. 中华高血压杂志,2011,19(9):818-821. DOI:10.16439/j.cnki.1673-7245. 2011. 09.007.

[22] Fessel J, Robertson D. Orthostatic hypertension: when pressor reflexes overcompensate[J]. Nat Clin Pract Nephrol,2006,2(8):424-431. DOI:10.1038/ncpneph0228.

[23] Raffai G, Mészáros M, Kollai M, et al. Experimental orthostasis elicits sustained hypertension, which can be prevented by sympathetic blockade in the rat[J]. J Cardiovasc Pharmacol,2005,45(4):354-361. DOI:10.1097/01.fjc.0000157440.57236.58.

[24] Izzo JL, Taylor AA. The sympathetic nervous system and baroreflexes in hypertension and hypotension[J]. Curr Hypertens Rep,1999,1(3):254-263. DOI:10.1007/s11906-999-0030-9.

[25] 赵娟,杜军保. 自主神经介导性晕厥儿童的血压变异性[J]. 中华儿科杂志,2012,50(9):712-713. DOI:10.3760/cma.j.issn.0578-1310.2012.09.017.

[26] Kario K. Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk[J].Circ J,2009,73(6):1002-1007. DOI:10.1253/circj.cj-09-0286.

[27] Buddineni JP, Chauhan L, Ahsan ST, et al. An emerging role for understanding orthostatic hypertension in the cardiorenal syndrome[J].Cardiorenal Med,2011,1(2):113-122. DOI:10.1159/000327141.

[28] Kario K. Systemic hemodynamic atherothrombotic syndrome and resonance hypothesis of blood pressure variability: triggering cardiovascular events[J]. Korean Circ J,2016,46(4):456-467. DOI:10.4070/kcj.2016. 46. 4.456.

[29] Vriz O, Soon G, Lu H, et al. Does orthostatic testing have any role in the evaluation of the young subject with mild hypertension?: an insight from the HARVEST study[J]. Am J Hypertens,1997,10(5 Pt 1):546-551. DOI:10.1016/s0895-7061(96)00489-x.

[30] Wijkman M, Länne T, Östgren CJ, et al. Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study[J]. Cardiovasc Diabetol,2016,15:83. DOI:10.1186/s12933-016-0399-0.

[31] Hoshide S, Kario K, Eguchi K, et al. Altered aortic properties in elderly orthostatic hypertension[J]. Hypertens Res,2005,28(1):15-19. DOI:10.1291/hypres.28.15.

[32] Nibouche-Hattab WN, Lanasri N, Zeraoulia F, et al. Orthostatic hypertension in normotensive type 2 diabetics: what characteristics?[J].Ann Cardiol Angeiol (Paris),2017,66(3):159-164. DOI:10.1016/j.ancard.2017.04.003.

[33] Barochiner J, Cuffaro PE, Aparicio LS, et al. Predictors of masked hypertension among treated hypertensive patients: an interesting association with orthostatic hypertension[J]. Am J Hypertens,2013,26(7):872-878. DOI:10.1093/ajh/hpt036.

[34] Fan XH, Wang Y, Sun K, et al. Disorders of orthostatic blood pressure response are associated with cardiovascular disease and target organ damage in hypertensive patients[J].Am J Hypertens,2010,23(8):829-837. DOI:10.1038/ajh.2010.76.

[35] Yatsuya H, Folsom AR, Alonso A, et al. Postural changes in blood pressure and incidence of ischemic stroke subtypes: the ARIC study[J].Hypertension,2011,57(2):167-173. DOI:10.1161/HYPERTENSIONAHA.110.161844.

[36] Veronese N, De Rui M, Bolzetta F, et al. Orthostatic changes in blood pressure and mortality in the elderly: the Pro.V.A study[J].Am J Hypertens,2015,28(10):1248-1256. DOI:10.1093/ajh/hpv022.

[37] 马静,方红薇,谢晓林,等. 中老年体位性高血压与尿微量白蛋白排泄率及左心室质量指数的相关性研究[J]. 中华全科医学,2020,18(10):1685-1687,1694. DOI:10.16766/j.cnki.issn.1674-4152.001593.

[38] 王璞,李涤病,戴娇,等. 老年体位性高血压和体位性低血压患者肾功能指标的差异[J]. 中华高血压杂志,2019,27(4):376-379. DOI:10.16439/j.cnki.1673-7245.2019.04.020.

[39] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension[J].Eur Heart J,2018,39(33):3021-3104. DOI:10.1093/eurheartj/ehy339.

[40] Rouabhi M, Durieux J, Al-Kindi S, et al. Orthostatic hypertension and hypotension and outcomes in CKD: the CRIC (chronic renal insufficiency cohort) study[J].Kidney Med,2021,3(2):206-215.e1. DOI:10.1016/j.xkme.2020.10.012.

[41] Parati G, Ochoa JE, Bilo G. Blood pressure variability, cardiovascular risk, and risk for renal disease progression[J]. Curr Hypertens Rep,2012,14(5):421-431. DOI:10.1007/s11906-012-0290-7.

[42] Kario K. Morning surge in blood pressure and cardiovascular risk: evidence and perspectives[J]. Hypertension,2010,56(5):765-773. DOI:10.1161/HYPERTENSIONAHA.110.157149.

[43] Kario K, Eguchi K, Nakagawa Y, et al. Relationship between extreme dippers and orthostatic hypertension in elderly hypertensive patients[J].Hypertension,1998,31(1):77-82. DOI:10.1161/01.hyp.31.1.77.

[44] Ricci F, Fedorowski A, Radico F, et al. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies[J].Eur Heart J,2015,36(25):1609-1617. DOI:10.1093/eurheartj/ehv093.

[45] Mesquita P, Queiroz D, Lamartine de Lima Silva V, et al. Prevalence of orthostatic hypertension in elderly patients with type 2 diabetes[J].Int J Endocrinol,2015,2015:463487. DOI:10.1155/2015/463487.

[46] Nibouche N, Lanasri N, Chibane A, et al. Orthostatic hypertension in normotensive patients predicts permanent arterial hypertension in type 2 diabetes mellitus[J].Journal of Hypertension,2016,34 Suppl 2:e12. DOI:10.1097/01.hjh.0000491357.33289.54.

[47] Bursztyn M, Jacobs JM, Hammerman-Rozenberg A, et al. Prevalence of orthostatic hypertension in the very elderly and its relationship to all-cause mortality[J]. J Hypertens,2016,34(10):2053-2058. DOI:10.1097/HJH. 0000000000001044.

[48] Curreri C, Giantin V, Veronese N, et al. Orthostatic changes in blood pressure and cognitive status in the elderly: the Progetto Veneto Anziani study[J].Hypertension,2016,68(2):427-435. DOI:10.1161/HYPERTENSIONAHA. 116. 07334.

[49] 伍焕平,曾汇庆,梁叶青. 从长期预后价值角度评价不同的直立性高血压判断标准[J]. 黑龙江医学,2020,44(8):1037-1039. DOI:10.3969/j.issn.1004-5775.2020.08.009.

[50] 曾汇庆. 老年人群直立性低血压、直立性高血压与全因死亡率的关系——5年随访研究[J]. 临床心血管病杂志,2019,35(1):52-55. DOI:10.13201/j.issn.1001-1439.2019. 01.013.

[51] Kostis WJ, Sargsyan D, Mekkaoui C, et al. Association of orthostatic hypertension with mortality in the Systolic Hypertension in the Elderly Program[J].J Hum Hypertens,2019,33(10):735-740. DOI:10.1038/s41371-019-0180-4.

[52] Agnoletti D, Valbusa F, Labat C, et al. Evidence for a prognostic role of orthostatic hypertension on survival in a very old institutionalized population[J].Hypertension,2016,67(1):191-196. DOI:10.1161/HYPERTENSIONAHA. 115.06386.

[53] Weiss A, Beloosesky Y, Grossman A, et al. The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons[J].J Geriatr Cardiol,2016,13(3):239-243. DOI:10.11909/j.issn.1671-5411. 2016. 03.004.

[54] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J].J Am Coll Cardiol,2018,71(19):e127-e248. DOI:10.1016/j.jacc.2017.11.006.

[55] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension[J].J Hypertens,2018,36(10):1953-2041. DOI:10.1097/HJH. 0000000000001940.

[56] «中国高血压防治指南»修订委员会. 中国高血压防治指南2018年修订版[J]. 心脑血管病防治,2019,19(1):1-44. DOI:10.3969/j.issn.1009-816X.2019.01.001.

[57] 李稳,左庆娟,李刚. 直立性高血压1例[J]. 中华高血压杂志,2019,27(4):392-394. DOI:10.16439/j.cnki.1673-7245. 2019.04.025.

[58] Chhabra L, Spodick DH. Orthostatic hypertension: recognizing an underappreciated clinical condition[J].Indian Heart J,2013,65(4):454-456. DOI:10.1016/j.ihj.2013.06.023.

[59] Cleophas TJ, Grabowsky I, Niemeyer MG, et al. Paradoxical pressor effects of beta-blockers in standing elderly patients with mild hypertension: a beneficial side effect[J].Circulation,2002,105(14):1669-1671. DOI:10.1161/01.cir.0000012745.50229.ac.

[60] Kario K, Shimada K, Pickering TG. Pressor effects of beta-blockers on standing blood pressure may be harmful for older patients with orthostatic hypertension[J]. Circulation,2002,106(24):e196-e197. DOI:10.1161/01.cir.0000041864.81147.fd.

Research progress in diagnosis and treatment and clinical significance of orthostatic hypertension

体位性高血压的诊疗及临床意义研究进展

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

[1]	Li Nan, Cui Xiujuan, Ding Baijuan, Duan Chao, Shi Juanjuan. One case of misdiagnosed invasive fibroma on abdominal wall and literature review [J]. International Medicine and Health Guidance News, 2022, 28(9): 1209-1212.
[2]	Tu Jiaoqin, Shi Jiaoyang, Fan Tao, Lei Qiong, Chen fengying. Clinical characteristics and management strategies of 2019-nCoV in pregnant women [J]. International Medicine and Health Guidance News, 2022, 28(9): 1243-1246.
[3]	Lin Jingshan, Tang Shiheng, Wang Yiyang, Li Yuxia. Functional exercise compliance in patients with stroke [J]. International Medicine and Health Guidance News, 2022, 28(9): 1251-1256.
[4]	Pei Mengge, Li Guqiang. Treatment strategies for shoulder-hand syndrome after stroke [J]. International Medicine and Health Guidance News, 2022, 28(9): 1326-1329.
[5]	Meng Yonghui. Research progress of osteoporotic spinal fracture [J]. International Medicine and Health Guidance News, 2022, 28(9): 1330-1332.
[6]	Wei Jianwen, Yin Wenjun, Chen Zekai, Ling Muan, Chen Jie, Pan Bin. Observation of clinical efficacy of early electrophysiological technology intervention in restoring urine control function after laparoscopic radical resection of prostate cancer [J]. International Medicine and Health Guidance News, 2022, 28(8): 1038-1041.
[7]	Qin Shuipen. Current situation and research progress of clinical treatment of diabetic retinopathy [J]. International Medicine and Health Guidance News, 2022, 28(8): 1180-1184.
[8]	Liu Zhilong, He Jing, Li Chongyu. Clinical experience of treating fever [J]. International Medicine and Health Guidance News, 2022, 28(7): 916-919.
[9]	Zhao Jing, Zheng Aiping. Ultrasound in diagnosis and treatment of tendon diseases of lower extremities [J]. International Medicine and Health Guidance News, 2022, 28(7): 953-956.
[10]	Wang Hao, Xie Qingzhi. Research progress of sulforaphane in treatment of Helicobacter pylori infection [J]. International Medicine and Health Guidance News, 2022, 28(7): 1021-1024.
[11]	Liu jing, Gai Xinxin, Liang Sen, Wei Xuegong. Research progress in etiology, diagnosis, and treatment of placenta previa [J]. International Medicine and Health Guidance News, 2022, 28(7): 1029-1033.
[12]	Tian Jie, Jin Yu, Liu Suqin. Research progress of plastic bronchitis in children [J]. International Medicine and Health Guidance News, 2022, 28(6): 805-808.
[13]	Tang Ming, Huang Wei. Idiopathic portal hypertension with gastrointestinal bleeding as first manifestation: a case report [J]. International Medicine and Health Guidance News, 2022, 28(6): 870-872.
[14]	Wang Wen, Cui Xiujuan, Tian Xiangyu. Diagnosis and treatment of endometriosis complicated with adenomyosis [J]. International Medicine and Health Guidance News, 2022, 28(5): 687-691.
[15]	Wu Xueting, Chen Xiaoyi, Wu Yiwen, Cai Yongna, Xiao Mingyue, Chen Fengjuan, Han Qianglin, Qiu Shaodong, Zhu Zhiming, Chen Fei. Advances in the application of ultrasound radiomics in breast cancer [J]. International Medicine and Health Guidance News, 2022, 28(4): 484-487.