Bp Fluctuations And Stroke?

[mkoven]

http://www.medpagetoday.com/Cardiology/Hypertension/20019

What are we to make of this?

[firewatcher]

I'm not really sure this applies to us. I'm betting that 90+% of their participants had intact vagal responses. I think that the concern is a sudden BP spike in weakened or hardened arteries from long-term hypertension either blowing out or releasing plaque from the arterial walls and causing the stroke. Granted, we have W-I-D-E swings in our BP, but most of POTS patients aren't hypertensive to begin with. Some of us are though. Migraine increases our chance of stroke just as much. Who knows if they even checked for autonomic responses in their study group....

[MomtoGiuliana]

I skimmed this so maybe I missed something but it appears the size of the study was pretty small (around 600 people) and the conclusion based on three readings (?) of each subject. Probably another case of "more research needed"...? Don't drs always say they can't base conclusions on just a few bp readings as it is normal for bp to fluctuate? I wonder if it is more a case of hypertension not getting identified in some patients b/c not enough readings are made?

[firewatcher]

Am J Hypertens. 2010 Apr 22. [Epub ahead of print]

Disorders of Orthostatic Blood Pressure Response Are Associated With Cardiovascular Disease and Target Organ Damage in Hypertensive Patients.

Fan XH, Wang Y, Sun K, Zhang W, Wang H, Wu H, Zhang H, Zhou X, Hui R.

Hypertension Division, Department of Cardiology, Cardiovascular Institute and FuWai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

BackgroundThe prevalence and clinical significance of orthostatic hypertension (OHT) remain largely undetermined in hypertensive patients. This study investigated the association of OHT and orthostatic hypotension (OH) with cardiovascular disease (CVD) and target organ damage (TOD) in hypertensive patients.MethodsA cross-sectional study was conducted in 4,711 hypertensives and 826 normotensives, aged 40-75 years. OHT was defined as an increase in systolic blood pressure (SBP) of >/=20 mm Hg, and OH was defined as either a reduction in SBP of at least 20 mm Hg or a reduction in diastolic BP (DBP) of at least 10 mm Hg during the first 3 min after standing.ResultsHypertension was only independently associated with a risk of OHT. After controlling for age, sex, and other confounders, OH was associated with peripheral artery disease (PAD) (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.15-1.89, P < 0.01), left ventricular hypertrophy (LVH) (OR 1.48, 95% CI 1.12-1.93, P < 0.001), coronary artery disease (CAD) (OR 1.71, 95% CI 1.12-2.61, P < 0.01), and stroke (OR 1.72, 95% CI 1.19-2.34, P < 0.01), but OHT was only associated with PAD (OR 1.36, 95% CI 1.05-1.81, P < 0.05) and stroke (OR 1.76, 95% CI 1.27-2.26, P < 0.01). The adjusted OR for PAD, predicted by the quintiles of the orthostatic SBP changes, showed a J-shaped relationship in untreated hypertensive patients, as was also the case for LVH in hypertensive women.ConclusionsOH is associated with CV risk; the associations of OHT with TOD and stroke in hypertensive patients still need to be confirmed in prospective studies.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.76.

PMID: 20414196