Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Abstract

Orthostatic hypertension (OHT), that is, sustained increase in blood pressure after standing, is an increasingly recognized cardiovascular disorder having been examined in much fewer studies compared with orthostatic hypotension (OH). However, in both OHT and OH, dysfunction of the autonomous nervous system is considered to be the primary pathophysiological disturbance, while significant associations with essential hypertension have been observed. Although in many studies OHT has been related to subclinical or clinical target organ damage, there is also evidence denying such an association. Because OHT is defined variably across different studies, the comparison of relevant outcomes is at least problematic. Since evidence about OHT treatment is exclusively based on limited non‐randomized studies, no specific recommendations have been developed. Therefore, both the prognostic role and the clinical significance of OHT remain largely undefined. The aim of the present review is to summarize the available evidence regarding the definition, diagnosis, pathophysiology, prognostic role and treatment of OHT and highlight potential clinical implications of this underestimated condition.

Orthostatic Hypertension in Children: An Update

“…The methods for diagnosing OHT mainly include the active standing test, the HUTT, BP self-measurement at home and 24-h ambulatory BP monitoring. OHT can be diagnosed based on BP elevation from supine to upright or the absolute value of upright BP (1). The active standing test is easy and safe to operate, and the HUTT is often used for differential diagnosis of the causes of OI in children.…”

“…In studies of adult patients, the majority of researchers defined OHT as an increase in SBP of at least 20 mmHg or an increase of diastolic BP (DBP) of at least 10 mmHg from supine to standing (1). For children and adolescents, a large cross-sectional investigation identified the 95th percentile of BP increase from supine to upright and the 95th percentile of upright BP values in children aged 6-18 years old (29).…”

“…Orthostatic hypertension (OHT) refers to a significant increase in blood pressure (BP) when in the upright position compared to the supine position, and it reflects the abnormal regulation of BP during postural changes. In adults, OHT is often seen in patients with essential hypertension or type 2 diabetes, and it is considered a risk factor for cardiovascular and cerebrovascular diseases and is related to target organ damage and poor prognosis ( 1 – 3 ). Pediatric OHT was first reported in 2012 by Zhao et al, and they described that most children with OHT were in puberty and presented dizziness and syncope as their main clinical manifestations, which were often induced by sudden postural changes or prolonged standing ( 4 ).…”

Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents

“…Streeten et al (1) first put forward the concept of OHT and studied its pathogenesis in the 1980s. Subsequently, multiple studies in adults with OHT show that OHT is seen in the elderly with essential hypertension or diabetes and patients with dysautonomias and also occurs in young adults with normal supine BP (2)(3)(4)(5). Furthermore, OHT is closely related to the subsequent cardiovascular and cerebrovascular diseases and central nervous system damage, and it was regarded as a new risk factor for cardiovascular and cerebrovascular diseases in adults (3,(6)(7)(8)(9)(10).…”

Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

“…1 Orthostatic hypertension was defined as an increase in systolic blood pressure ≥20 mmHg upon standing. 2 We also conducted sensitivity analyses with alternate thresholds for defining orthostatic hypotension and hypertension.…”