Background Hypertension (HTN) while asleep is strongly associated with cardiovascular disease (CVD) and death. Whether HTN while supine in clinic is a risk factor for CVD independent of seated BP remains unknown.
Objectives To determine the relationship between supine HTN and adverse CVD.
Methods The Atherosclerosis Risk in Communities (ARIC) Study measured supine and seated BP during visit 1 (1987-1989). Supine HTN was defined as a supine systolic BP (SBP) ≥130 or diastolic BP (DBP) ≥80 mm Hg and seated HTN was defined as a seated SBP ≥130 or DBP ≥80mm Hg. We excluded participants with a history of coronary heart disease (CHD), heart failure, or stroke and examined the association of supine HTN with incident CHD, heart failure, stroke, fatal CHD, and all-cause mortality using Cox models adjusted for seated HTN and CVD risk factors. Analyses were repeated in strata of HTN treatment.
Results Of 11,369 participants (56% female, 25% Black, mean age [53.9±5.7 years]), 16% of those without seated HTN had supine HTN, while 74% of those with seated HTN had supine HTN. Over a median of 25-28 years of follow-up, despite adjustment for seated HTN, supine HTN was associated with incident CHD (HR 1.60; 95% CI: 1.45, 1.76), heart failure (1.83; 1.68,2.01), stroke (1.86; 1.63, 2.13), fatal CHD (2.18; 1.84, 2.59), and all-cause mortality (1.43; 1.35,1.52). Results did not differ by HTN medication use (P-interactions >0.05). Participants with supine HTN alone, had a risk similar to HTN in both positions (Figure).
Conclusion Participants with supine HTN had a significantly higher risk of adverse CVD events independent of seated HTN. Supine HTN screening should be further evaluated in a clinical trial.
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