- An analysis of data from a long-running study of more than 11,000 adults from four diverse communities in the United States has found that adults who had high blood pressure while both seated upright and lying supine (flat on their backs) had a higher risk of heart disease, stroke, heart failure or premature death compared to adults without high blood pressure while upright and supine.
- Adults who had high blood pressure while lying supine but not while seated upright had similar elevated risks of heart attack, stroke, heart failure or premature death as adults who had high blood pressure in both supine and upright positions.
- The increased risk of heart disease, stroke, heart failure or premature death did not differ by the type of blood pressure medication used among participants.
Embargoed until 6:30a.m. CT/7:30 a.m. ET Thursday, Sept. 7, 2023
BOSTON, Sept. 7, 2023 — People who had high blood pressure while lying flat on their backs had a higher risk of heart attack, stroke, heart failure or premature death, according to new research to be presented at the American Heart Association’s Hypertension Scientific Sessions 2023, to be held Sept. 7-10, 2023, in Boston. The meeting is the premier scientific exchange focused on recent advances in basic and clinical research on high blood pressure and its relationship to cardiac and kidney disease, stroke, obesity and genetics.
The autonomic nervous system regulates blood pressure in different body positions; however, gravity may cause blood to pool when seated or upright, and the body is sometimes unable to properly regulate blood pressure during lying, seated and standing positions, the authors noted.
“If blood pressure is only measured while people are seated upright, cardiovascular disease risk may be missed if not measured also while they are lying supine on their backs,” said lead study author Duc M. Giao, a researcher and a 4th-year M.D. student at Harvard Medical School in Boston.
To examine body position, blood pressure and heart health risk, the researchers examined health data for 11,369 adults from the longitudinal Atherosclerosis Risk in Communities (ARIC) study. The data on supine and seated blood pressure was gathered during the enrollment period, ARIC visit 1, which took place between 1987–1989. Participants had their blood pressure taken while briefly lying down at a clinic. The average age of participants at that time was 54 years old; 56% of the group self-identified as female; and 25% of participants self-identified as Black race. Participants in this analysis were followed for an average of 25 to 28 years, up through ARIC visit 5, which includes health data collected from 2011-2013.
The researcher’s findings included:
- 16% percent of participants who did not have high blood pressure — defined in this study as having top and bottom blood pressure measures greater than or equal to 130/80 mm Hg — while seated had high blood pressure while lying supine (flat on their backs), compared to 74% of those with seated high blood pressure who also had supine high blood pressure.
- In comparison to participants who did not have high blood pressure while seated and supine, participants who had high blood pressure while seated and supine had a 1.6 times higher risk of developing coronary heart disease; a 1.83 times higher risk of developing heart failure; a 1.86 times higher risk of stroke; a 1.43 times higher risk of overall premature death; and a 2.18 times higher risk of dying from coronary heart disease
- Participants who had high blood pressure while supine but not while seated had similar elevated risks as participants who had high blood pressure while both seated and supine.
- Differences in blood pressure medication use did not affect these elevated risks in either group.
“Our findings suggest people with known risk factors for heart disease and stroke may benefit from having their blood pressure checked while lying flat on their backs,” Giao said.
“Efforts to manage blood pressure during daily life may help lower blood pressure while sleeping. Future research should compare supine blood pressure measurements in the clinic with overnight measurements.”
The study’s limitations included that it focused on adults who were middle-aged at the time of enrollment, meaning the results might not be as generalizable to older populations, Giao said.
Note: Giao presents Seated And Supine Blood Pressure And Risk Of Cardiovascular Disease And Mortality From The Atherosclerosis Risk In Communities Study at 2:15 p.m. ET on Saturday, Sept. 9, 2023, Presentation #071; Abstract #452
- The Atherosclerosis Risk in Communities (ARIC) study is an ongoing, community-based cohort of 15,792 adults in the United States enrolled from 1987-1989 to investigate the causes for atherosclerotic disease (plaque or fatty buildup in the arteries). ARIC study participants were ages 45–65 years at the start of the study and from rural areas in the U.S. (Forsyth County, North Carolina, and Washington County, Maryland) and urban areas: Minneapolis and Jackson, Mississippi. The research and data from the ARIC clinical visits — including hospital record abstraction, ECG tracings, and physician and coroner questionnaires, as well as death certificate data — have led to discoveries and guidelines surrounding atherosclerosis, heart disease, kidney disease, diabetes, stroke and cognitive decline.
- The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults classifies hypertension as having top and bottom numbers greater than or equal to 130/80 mm Hg, which was the definition of hypertension used in this study.
Co-authors and their disclosures are listed in the abstract. The study was funded by the National Institutes of Health.
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- Program abstracts online at embargo
- AHA news release: If blood pressure rises upon standing, so may risk for heart attack (March 2022)
- AHA news release: Blood pressure rising at night linked to doubling risk of death in adults with diabetes (Sept. 2021)
- AHA news release: Abnormal blood pressure levels while sleeping increase risk of heart disease (November 2020)
- Follow AHA/ASA news on X (formerly known as Twitter) @HeartNews #Hypertension23
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