Association of orthostatic hypertension identified according to different definitions with cardiovascular disease. The PARTAGE study

OBJECTIVE: Diagnostic criteria for an exaggerated BP increase in response to standing (ERTS) are still debated making it difficult to interpret data regarding the cardiovascular risk associated with ERTS. The aim of the present study was to identify the ERTS definition that was most strongly associated with cardiovascular disease. DESIGN AND METHODS: The study was conducted within the frame of the PARTAGE study, in 920 individuals aged 80 years or older. BP was measured 1 min and 3 min after standing up. Participants were classified into three groups according to whether they had normal response to standing (reference group), orthostatic hypotension, or ERTS defined using 16 different definitions. The risk of adverse cardiovascular outcomes was explored by means of multivariable survival Cox analyses. RESULTS: ERTS was associated with both cardiovascular events and mortality when it was identified according to three definitions: SBP ≥20 mmHg in either orthostatic measurement [hazard ratios (HRs) (95% confidence interval, CI), 1.45 (1.03-2.03; P  = 0.031)] and 1.71 (1.05-2.77; P  = 0.030), respectively; SBP ≥15 mmHg in either orthostatic measurement ((1.43 (1.03-1.99; P  = 0.032) and 1.82 (1.12-2.94; P  = 0.015)), respectively; and SBP ≥20 mmHg and/or DBP ≥15 mmHg in either orthostatic measurement ((1.42 (1.03-1.98; P  = 0.035) and 1.94 (1.19-3.17; P  = 0.008)), respectively. The best model fit was found for SBP and DBP combined. No independent association with both outcomes was found for other ERTS definitions. CONCLUSIONS: The present results show that an SBP increase of >15-20 mmHg is a more important prognostic indicator than less pronounced increases of SBP. However, associating also an increase in DBP of ≥15 mmHg slightly increased the predictive value of ERTS.