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From the Journals

Supine Hypertension: A Missed Opportunity in CVD Prevention?

Study finds supine hypertension independently increases cardiovascular disease risk.

Conexiant

Patients with supine hypertension alone had a comparable risk of cardiovascular disease and mortality to those with hypertension in both seated and supine positions, suggesting supine hypertension may be an important factor in cardiovascular risk assessment, according to a recent study. 

Investigators analyzed the association between supine hypertension and cardiovascular disease (CVD) outcomes in a cohort of middle-aged adult patients. In the study, published in JAMA Cardiology, the investigators analyzed data from 11,369 participants without prior CVD who underwent seated and supine blood pressure (BP) measurements, with longitudinal follow-up over 27 years.

Supine hypertension was defined as a supine systolic BP of at least 130 mmHg or a diastolic BP of at least 80 mmHg. Among the participants, 16.4% of those without seated hypertension had supine hypertension, whereas 73.5% of those with seated hypertension also had supine hypertension. The prevalence of supine hypertension was higher among male (44.3%) and Black (25.1%) participants. The study utilized Cox proportional hazard models adjusted for cardiovascular risk factors to evaluate the association of supine hypertension with CVD outcomes.

The investigators from the Atherosclerosis Risk in Communities study, led by Duc M. Giao, MD, and colleagues, noted that supine hypertension was significantly associated with an increased risk of coronary heart disease (CHD), heart failure, stroke, fatal coronary heart disease, and all-cause mortality. These associations were independent of seated hypertension status and antihypertensive medication use. Further, the participants with supine hypertension alone had comparable CVD risk to those with hypertension in both seated and supine positions.

Compared with supine hypertension, seated hypertension alone was associated with a significantly lower risk of CHD, heart failure, stroke, and all-cause mortality. Supine hypertension was associated with increased CVD risk independent of seated hypertension status, warranting further exploration of its role in risk assessment.

Full disclosures can be found in the published study.