Greater Change of Orthostatic Blood Pressure Is Related to Silent Cerebral Infarct and Cardiac Overload in Hypertensive Subjects

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Abstract
Greater change of postural blood pressure (BP) is often seen in elderly hypertensives and is recognized as a risk factor for cognitive decline and poorer cerebrovascular outcome, but its clinical significance still remains to be clarified. We performed a head-up tilting test, ambulatory BP monitoring, and brain MRI in 59 hypertensives and 27 normotensive subjects. We measured plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels at rest to assess cardiac burden. The 59 hypertensive patients were classified into 3 groups: an orthostatic hypertension (OHT) group with orthostatic increase in systolic BP (SBP) ≥10 mmHg (n =16); an orthostatic hypotension (OHYPO) group with orthostatic SBP decrease ≤-10 mmHg (n =18); and an orthostatic normotension (ONT) group with neither of these two patterns (n =25). A group of 27 normotensive subjects (NT) was also included as a control. Plasma BNP (72±92 vs. 29±24 pg/ml, p vs. 2.4±1.5, p vs. 2.4±1.5, p Hypertens Res 2004; 27: 235-241)