Orthostatic hypertension

This article is about the uncommon condition of blood pressure increasing (HYPERtension) when standing up. For the more common condition of blood pressure decreasing (HYPOtension) when standing up, see Orthostatic hypotension.
Orthostatic hypertension
Other namesPostural hypertension
SpecialtyNeurology, cardiology

Orthostatic hypertension is a medical condition consisting of a sudden and abrupt increase in blood pressure (BP) when a person stands up.[1] Orthostatic hypertension is diagnosed by a rise in systolic BP of 20 mmHg or more when standing. Orthostatic diastolic hypertension is a condition in which the diastolic BP raises to 98 mmHg or over in response to standing,[2][3][4] but this definition currently lacks clear medical consensus, so is subject to change. Orthostatic hypertension involving the systolic BP is known as systolic orthostatic hypertension.

High diastolic blood pressure measured while standing in a person who stood up shortly after waking up.

When it affects an individual's ability to remain upright, orthostatic hypertension is considered as a form of orthostatic intolerance. The body's inability to regulate blood pressure can be a type of dysautonomia.

Baroreflex and autonomic pathways normally ensure that blood pressure is maintained despite various stimuli, including postural change. The precise mechanism of orthostatic hypertension remains unclear, but alpha-adrenergic activity may be the predominant pathophysiologic mechanism of orthostatic hypertension in elderly hypertensive patients.[5] Other mechanisms are proposed for other groups with this disorder.[1]

A prevalence of 1.1% was found in a large population study.[6] The risk of orthostatic hypertension has been found to increase with age, with it being found in 16.3% of older hypertensive patients.[7]

  1. ^ a b Fessel J, Robertson D (August 2006). "Orthostatic hypertension: when pressor reflexes overcompensate". Nature Clinical Practice. Nephrology. 2 (8): 424–431. doi:10.1038/ncpneph0228. PMID 16932477. S2CID 20184856.
  2. ^ Bell, David S. (May 2000). "Orthostatic Intolerance (OI) Test Results". Lyndonville News. 2 (3).
  3. ^ Streeten, D.H.P. (1987). Orthostatic Disorders of the Circulation. New York: Plenum Medical. p. 116. ISBN 978-1-4684-8962-0.
  4. ^ Jordan, Jens; Biaggioni, Italo; Kotsis, Vasilios; Nilsson, Peter; Grassi, Guido; Fedorowski, Artur; Kario, Kazuomi (February 2023). "Consensus statement on the definition of orthostatic hypertension endorsed by the American Autonomic Society and the Japanese Society of Hypertension". Hypertension Research. 46 (2): 291–294. doi:10.1038/s41440-022-01074-0. ISSN 1348-4214. PMC 9899687.
  5. ^ Kario K, Eguchi K, Hoshide S, Hoshide Y, Umeda Y, Mitsuhashi T, Shimada K (July 2002). "U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor". Journal of the American College of Cardiology. 40 (1): 133–141. doi:10.1016/S0735-1097(02)01923-X. PMID 12103267.
  6. ^ Wu JS, Yang YC, Lu FH, Wu CH, Chang CJ (May 2008). "Population-based study on the prevalence and correlates of orthostatic hypotension/hypertension and orthostatic dizziness". Hypertension Research. 31 (5): 897–904. doi:10.1291/hypres.31.897. PMID 18712045.
  7. ^ Fan XH, Sun K, Zhou XL, Zhang HM, Wu HY, Hui RT (January 2011). "[Association of orthostatic hypertension and hypotension with target organ damage in middle and old-aged hypertensive patients]". Zhonghua Yi Xue Za Zhi. 91 (4): 220–224. PMID 21418863.