Hypertension While Lying Down Linked to Elevated Risk for CVD Events

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Individuals with hypertension (HTN) while in a supine position had an elevated risk for cardiovascular disease (CVD) even if they did not have HTN while seated, according to new research.

Investigators presented the data at the American Heart Association’s (AHA) Hypertension Scientific Sessions 2023, held September 7-10 in Boston, Massachusetts.

“If blood pressure is only measured while people are seated upright, cardiovascular disease risk may be missed if not measured also while they are lying supine on their backs,” said lead author Duc M. Giao, a researcher and fourth-year MD student at Harvard Medical School, in an AHA press release.

To analyze body position, blood pressure (BP), and CVD risk, Giao and colleagues examined health data for 11 369 participants (mean age, 54 years; 56% women; 25% Black) from the Atherosclerosis Risk in Communities (ARIC) study. They gathered data on supine and seated BP, both defined as at least 130 mm Hg systolic or at least 80 mm Hg diastolic as measured from the respective position, which was assessed at their first visit from 1987 to 1989. All participants had no history of coronary heart disease (CHD), heart failure (HF), or stroke at baseline.

Participants were followed for an average of 25 to 28 years, according to the press release.

FINDINGS

Among the cohort, 16% of participants who did not have HTN while seated had supine HTN, and 74% of those who had seated HTN had supine HTN, according to the researchers.

Compared to participants who did not have seated HTN or supine HTN, those who did have seated HTN or supine HTN faced a 1.6-times higher risk of developing CHD; a 1.83-times higher risk of developing HF; a 1.86-times higher risk of stroke; a 1.43-times higher risk of overall premature death; and a 2.18-times higher risk of dying from CHD.

The results were consistent regardless of HTN medication use, according to the press release. Investigators also found that the risk curves were similar in patients with supine HTN only and in patients with both supine and seated HTN.

“Our findings suggest people with known risk factors for heart disease and stroke may benefit from having their blood pressure checked while lying flat on their backs,” stated Giao. “Efforts to manage blood pressure during daily life may help lower blood pressure while sleeping. Future research should compare supine blood pressure measurements in the clinic with overnight measurements.”

The results may not be generalizable to older populations, noted Giao in the release, due to the fact that the study focused on middle-aged adults at the time of enrollment.

Giao will present the abstract Seated and supine blood pressure and risk of cardiovascular disease and mortality from the Atherosclerosis Risk in Communities Study at 2:15pm ET on Saturday, September 9, 2023, Presentation #071; Abstract #452.