Abstract 038: The Association Of Supine Hypertension Versus Standing Hypotension With Adverse Cardiovascular Events Among Middle-aged Adults

Background: Clinical management of orthostatic hypotension (OH) prioritizes the prevention of standing hypotension (HYP), sometimes at the expense of supine hypertension (HTN). It is unclear whether supine HTN is associated with adverse outcomes relative to standing HYP. Objectives: To compare supine HTN and standing HYP among middle-aged adults with and without OH. Methods: The Atherosclerosis Risk in Communities Study measured supine and standing blood pressure (BP) in adults aged 45-64 between 1987-1989. We defined OH as a positional drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg, supine HTN as a BP≥140/≥90 mmHg, and standing HYP as a BP≤105/≤65 mmHg. ARIC participants were followed >30 years. Coronary heart disease (CHD) and mortality were adjudicated; falls and syncope were based on hospital claims. We used adjusted Cox models that included both supine HTN and standing HYP. Results: Of 12,580 participants (55% female, 26% Black, mean age 54±6) 5% had OH. Among those without OH (N=11936), 19% had supine HTN and 21% had standing HYP, while among those with OH (N=644), 11% had supine HTN and 34% had standing HYP. Supine HTN was associated with CHD (HR 1.49; 1.36, 1.63), syncope (HR 1.26; 1.15, 1.39), and all-cause mortality (HR 1.47; 1.38, 1.57), while standing HYP was only associated with all-cause mortality (HR 1.08; 1.00, 1.16) and to a lesser extent than supine HTN (P comparing coefficients 0.25). Conclusion: Supine HTN was associated with more adverse events than standing HYP, regardless of OH status, questioning conventional practices of prioritizing standing HYP among adults with OH.