Physiopathological mechanisms of orthostatic arterial hypertension
DOI:
https://doi.org/10.52692/1857-0011.2024.1-78.24Keywords:
hypertension, cardiovascular risk, orthostatismAbstract
The definition, prognostic role and clinical importance of orthostatic arterial hypertension (OHTA) have long remained unclear, in the context in which this pathology is little studied. Recent data have reported evidence that OHT correlates with masked arterial hypertension and target organ damage resulting from elevated blood pressure, the occurrence of various cardiovascular diseases, as well as an increased risk of mortality. Most of the evidence comes from studies in which OHT was defined using, as a benchmark, the increase in systolic blood pressure, while the clinical relevance of the increase in diastolic blood pressure values, currently, still remains unclear. The most recent consensus regarding the term orthostatic hypertension is provided by the Japanese Society of Hypertension, which defines it as an increase in systolic BP of ≥20 mmHg, associated with a systolic blood pressure value of at least 140 mmHg, when passing from the clinoin orthostatism. The pathophysiological mechanisms underlying this phenotype of hypertension are still controversial, varying with age. In young people, excessive activity of the neurohumoral system seems to be the determining cause, while with age, vascular stiffness plays a significant role in the occurrence of orthostatic arterial hypertension. Analyzing the latest data from the specialized literature, we observe that pathologies such as diabetes, activity disorders of the baroreflex system, essential arterial hypertension, can also induce the appearance of OHT. People with a tendency to increase blood pressure values, need to be subjects to periodic measurements of blood pressure values, including clino and otostatism.
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