[Association of orthostatic hypertension and hypotension with target organ damage in middle and old-aged hypertensive patients].

OBJECTIVE

To investigate the association of orthostatic hypertension and hypotension with hypertensive target organ damage in middle and old-aged hypertensive patients.

METHODS

This cross-section study was conducted in 4711 hypertensive patients aged 40-75 years old in 7 communities of Xinyang County, Henan Province by a multistage cluster sampling method. All patients received a standardized questionnaire, physical and biochemical examinations, echocardiography, ankle-brachial blood pressure index and orthostatic blood pressure measurement. Orthostatic hypertension was defined as an elevation of systolic blood pressure by 20 mm Hg or more while orthostatic hypotension as a drop of blood pressure by 20/10 mm Hg or more. When an upright posture was assumed. Others not belonging to these two conditions were classified into orthostatic normotension.

RESULTS

The prevalence of orthostatic hypertension and hypotension was 16.3% and 23.8% in hypertensive patients. Peripheral artery disease was significantly more frequent in hypertensives with orthostatic hypertension (10.1%) or hypotension (10.7%) than those with orthostatic normotensives (7.4%) (both P<0.05). Patients with orthostatic hypotension had more common left ventricular hypertrophy (53.0% vs 43.2%, P<0.001) and a decreased estimated glomerular filtration rate (38.6% vs 34.4%, P<0.05) than did those with orthostatic normotension. After controlling for age, gender, body mass index and other confounders, orthostatic hypertension was positively associated with peripheral arterial disease (OR 1.39, 95%CI 1.05-1.84) while orthostatic hypotension was significantly associated with peripheral arterial disease (OR 1.45, 95%CI 1.13-1.86) and left ventricular hypertrophy (OR 1.46, 95%CI 1.11-1.84). But no independent association was found between orthostatic hypertension or hypotension and a decreased estimated glomerular filtration rate in hypertensive patients. The adjusted odds ratios (OR) for left ventricular hypertrophy, as predicted by the quintiles of orthostatic systolic blood pressure changes, showed a J-shaped relationship in hypertensive women, and so did peripheral artery disease in untreated hypertensive patients.

CONCLUSION

Hypertensive patients with orthostatic hypertension or hypotension may have an elevated risk of developing target organ damage.