Does increased arterial stiffness increase the risk for postural hypotension?

This study tests the hypothesis that increased arterial stiffness is associated with postural hypotension in older adults. Aortic pulse wave velocity and postural blood pressure (BP) response were assessed in 49 nondiabetic community-dwelling normotensive (n=27) and hypertensive (n=22) older adults (mean age+/-SD, 71+/-6.7 years) who were not receiving vasoactive medications. During the 5-minute period of upright posture, 13 subjects had no change or a postural increase in systolic BP (SBP)(+10.6+/-14.6 mm Hg), 27 had a postural decrease of <20 mm Hg (-9.3+/-4.2 mm Hg), and nine had a postural decrease of >20 mm Hg (-29.1+/-8.1 mm Hg). Contrary to the proposed hypothesis, pulse wave velocity was significantly greater in subjects with a postural increase in SBP than in those with a postural decrease in SBP<20 mm Hg (10.2+/-0.68 m/sec vs. 8.3+/-0.37 m/sec; p=0.03) and tended to be greater than in those with a postural decrease in SBP>20 mm Hg (10.2+/-0.68 m/s vs. 8.5+/-0.73 m/sec; p=0.11). Higher pulse wave velocity was associated with a more positive postural SBP response at 1 minute (r=0.42; p=0.024), 3 minutes (r=0.38; p=0.007), and 5 minutes (r=0.45; p=0.001). This study does not support a relationship between arterial stiffness and a postural decrease in BP among healthy older adults; other age-related factors regulating BP homeostasis likely play a greater role.