Rise in Blood Pressure Upon Standing Could Signal Danger

March 17, 2022

If your blood pressure spikes when you stand, you may be at increased risk for heart attack and stroke, Italian researchers warn.

"The results of the study confirmed our initial hypothesis - a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure," said lead study author Dr. Paolo Palatini. He is a professor of internal medicine at the University of Padova, in Italy.

"We were rather surprised that even a relatively small increase in standing blood pressure (6 to 7 mm Hg) was predictive of major cardiac events in the long run," Palatini added.

The new study included more than 1,200 Italian adults, aged 18 to 45, with untreated stage 1 high blood pressure, defined as systolic blood pressure of 140 to 159 mm Hg and/or diastolic blood pressure of 90 to 100 mm Hg. (Systolic blood pressure is the force exerted on blood vessels when the heart beats; a diastolic reading measures pressure between beats.)

None of the participants had taken blood pressure-lowering medication prior to the study, and all were initially judged to be at low risk for major heart events based on their lifestyle and medical history - no diabetes, kidney impairment or heart disease.

At the outset, blood pressure readings were taken with participants in various physical positions, including lying down and after standing up.

Among the participants with the highest rise in blood pressure upon standing, the top 10% averaged an 11.4 mm Hg increase in blood pressure; all were greater than 6.5 mm Hg. The other participants averaged a 3.8 mm Hg drop in systolic pressure upon standing.

During an average 17-year follow-up, study participants experienced 105 major heart-related events, with the most common being heart attack, heart-related chest pain and stroke.

Odds of a major heart event were almost double for people in the top 10% group, the investigators found.

After adjusting for average blood pressure taken over 24 hours, the researchers concluded that a large increase in blood pressure upon standing remained a predictor of heart attack, stroke and other major cardiovascular events.

The study - published March 17 in the journal Hypertension - suggests the need for tailored interventions, Palatini said.

"The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood pressure-lowering therapy may be considered for people with an elevated [hyperreactor] blood pressure response to standing," he said in a journal news release.

More information

There's more on high blood pressure at the U.S. National Heart, Lung, and Blood Institute.

SOURCE: Hypertension, news release, March 17, 2022

Heart / Stroke-Related: High Blood Pressure Heart Attack: Management / Prevention