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.
References
Jordan J, Ricci F, Hoffmann F, Hamrefors V, Fedorowski A. Orthostatic hypertension: critical appraisal of an overlooked condition. Hypertension. 2020; 75:1151– 1158. doi: 10.1161/HYPERTENSIONAHA.120.1434
Kario K. Orthostatic hypertension—a new haemodynamic cardiovascular risk factor. Nat Rev Nephrol. 2013; 9:726–738. doi: 10.1038/nrneph.2013.224
J. Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos G, Doumas M, Papadopoulos D, Tousoulis D. Orthostatic hypertension: from pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens. 2019; 21:426–433. doi: 10.1111/jch.13491
Jordan J, Biaggioni I, Kotsis V, Nilsson P, Grassi G, Fedorowski A, Kario K. Consensus statement on the definition of orthostatic hypertension endorsed by the American Autonomic Society and the Japanese Society of Hypertension. Clin Auton Res. 2023; 46:291–294. doi: 10.1038/s41440-022-01074-0
Streeten DH, Auchincloss-JH J, Anderson- GH J, Richardson RL, Thomas FD, Miller JW. Orthostatic hypertension. Pathogenetic studies. Hypertension. 1985;7:196–203. doi: 10.1161/01.HYP.7.2.196.
Kario K, Eguchi K, Hoshide S, Hoshide Y, Umeda Y, Mitsuhashi T, Shimada K. U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor. J Am Coll Cardiol. 2002;40:133–141. doi: 10.1016/S0735-1097(02)01923-X.
Hoshide S, Parati G, Matsui Y, Shibazaki S, Eguchi K, Kario K. Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin. Hypertens Res. 2012;35:100–106. doi: 10.1038/hr.2011.156.
Kario K, Eguchi K, Nakagawa Y, Motai K, Shimada K. Relationship between extreme dippers and orthostatic hypertension in elderly hypertensive patients. Hypertension. 1998;31:77–82. doi: 10.1161/01. HYP.31.1.77.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, Horio T, Hoshide S, Ikeda S, Ishimitsu T, Ito M, Ito S, Iwashima Y, Kai H, Kamide K, Kanno Y, Kashihara N, Kawano Y, Kikuchi T, Kitamura K, Kitazono T, Kohara K, Kudo M, Kumagai H, Matsumura K, Matsuura H, Miura K, Mukoyama M, Nakamura S, Ohkubo T, Ohya Y, Okura T, Rakugi H, Saitoh S, Shibata H, Shimosawa T, Suzuki H, Takahashi S, Tamura K, Tomiyama H, Tsuchihashi T, Ueda S, Uehara Y, Urata H, Hirawa N (2019) The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res 42:1235–1481
Brunkwall L, Jönsson D, Ericson U, Hellstrand S, Kennbäck C, Östling G, Jujic A, Melander O, Engström G, Nilsson J, Ohlsson B, Klinge B, Orho-Melander M, Persson M, Nilsson PM (2021) The Malmö Offspring Study (MOS): design, methods and first results. Eur J Epidemiol 36:103–116.
Choi JY, Ryu DR, Lee HY, Lee JH, Hong Y, Park SK, Lee JH, Hwang SJ, Kim KH, Hwa Lee S, Kim SY, Park JH, Kim SH, Kim HL, Choi JH, Kim CH, Cho MC, Kim KI. Association Between Orthostatic Hypertension and Frailty Among Older Patients With Hypertension. Hypertension. 2024 Mar 21. doi: 10.1161/ HYPERTENSIONAHA.123.22382.
Palatini P, Mos L, Rattazzi M, Ermolao A, Battista F, Vriz O, Canevari M, Saladini F. Exaggerated blood pressure response to standing in young-to-middle-age subjects: prevalence and factors involved. Clin Auton Res. 2023; doi: 10.1007/s10286-023-00942-0.
Johansson M, Fedorowski A, Jordan J, Engström G, Nilsson PM, Hamrefors V. Orthostatic blood pressure adaptations, aortic stiffness, and central hemodynamics in the general population: insights from the Malmö Offspring Study (MOS). Clin Auton Res. 2023; 33:29–40. doi: 10.1007/s10286-022-00911-z.
Eguchi K, Kario K, Hoshide S, Ishikawa J, Morinari M, Shimada K. Greater change of orthostatic blood pressure is related to silent cerebral infarct and cardiac overload in hypertensive subjects. Hypertens Res. 2004; 27:235–241. doi: 10.1291/hypres.27.235.
Mesquita P, Queiroz D, Lamartine de Lima Silva V, Texeira VC, Vilaça de Lima YR, Júnior ER, Garcia J, Bandeira F. Prevalence of orthostatic hypertension in elderly patients with type 2 diabetes.Int J Endocrinol. 2015; 2015:463487. doi: 10.1155/2015/463487.
Palatini P, Mos L, Saladini F, Rattazzi M. Blood pressure hyperreactivity to standing: a predictor of adverse outcome in young hypertensive patients. Hypertension. 2022; 79:984–992. doi: 10.1161/HYPERTENSIONAHA.121.1857.
Thomas RJ, Liu K, Jacobs DR, Bild DE, Kiefe CI, Hulley SB. Positional change in blood pressure and 8-year risk of hypertension: the CARDIA Study. Mayo Clin Proc. 2003; 78:951–958. doi: 10.4065/78.8.951.
Downloads
Published
License
Copyright (c) 2024 Bulletin of the Academy of Sciences of Moldova. Medical Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
