Blood pressure measurements are commonly taken while individuals are sitting, but this may not provide a complete understanding of their cardiovascular health. Recent research presented at the American Heart Association’s Hypertension Scientific Sessions 2023 suggests that individuals who only have high blood pressure while lying down, known as supine hypertension, may face similar risks for heart failure, stroke, coronary heart disease, fatal coronary heart disease, and all-cause mortality as those with high blood pressure while both sitting and lying down.
Blood pressure is a measure of the force exerted by blood against the blood vessels during heart contractions (systolic) and at rest (diastolic). Typically, a normal blood pressure reading is 120/80 mm Hg. The study aimed to determine if supine hypertension alone could be a risk factor for adverse cardiovascular outcomes. Researchers analyzed data from the Atherosclerosis Risk in Communities (ARIC) Study, including 11,369 participants without a history of coronary heart disease, heart failure, or stroke. Supine high blood pressure was defined as a reading of 130 mm Hg systolic or 80 mm Hg diastolic while lying down. Seated high blood pressure was defined using the same parameters while sitting.
Among the participants, 16% had normal blood pressure while seated but high blood pressure while lying down. Additionally, 74% of those with high blood pressure while seated also had high blood pressure while lying down. The average follow-up time was 25-28 years, and the researchers found that individuals with both seated and supine high blood pressure had an increased risk of adverse cardiovascular outcomes. Interestingly, the risk was similar for those who only had high blood pressure while lying down, and the use of medication for high blood pressure did not affect the results.
Dr. Michael Broukhim, a board-certified interventional cardiologist, emphasized the importance of measuring blood pressure in different positions. He stated that relying solely on seated blood pressure measurements may miss hypertension in a significant portion of middle-aged adults. Dr. Cheng-Han Chen, an interventional cardiologist, added that these findings have critical implications for blood pressure management strategies and highlight the need to measure blood pressure while lying down.
It is worth noting that this study does not establish a causal relationship between the factors examined, and more blood pressure measurements could have provided even more accurate information. Additionally, the study has not yet undergone peer review. Dr. Keith C. Ferdinand, a professor of medicine, expressed the need for confirmation through full peer-reviewed analyses and suggested that supine blood pressure may be a surrogate for individuals whose blood pressure does not adequately lower when at rest.
While measuring blood pressure while lying down may provide a more comprehensive assessment of cardiovascular health, there are challenges to implementing this in a clinical setting. Time constraints for clinicians and the additional complexity of analyzing and interpreting supine blood pressure readings may pose barriers. However, there is potential to incorporate supine blood pressure measurements for specific individuals who present with normal seated blood pressure and have a clinical suspicion of hypertension. Dr. Broukhim recommended the use of ambulatory systolic blood pressure monitors for individuals with elevated clinical suspicion.
Dr. Chen also highlighted the significance of these findings and suggested adopting supine blood pressure measurements as a standard technique whenever possible. Individuals concerned about their blood pressure should consult with their doctors to explore accurate measurement options. High blood pressure can be managed through a personalized treatment plan, which may include medication and lifestyle changes such as smoking cessation and alcohol moderation.