Alyssa Torjesen , BS 1 , Leroy L. Cooper , PhD 1 , 2 , Jian Rong 3 , Martin G. Larson , ScD 3 , 4 , Naomi M. Hamburg , MD 5 , 6 , Daniel Levy , MD 3 , 7 , Emelia J. Benjamin , MD, ScM 3 , 5 , 6 , 8 , Ramachandran S. Vasan , MD 3 , 5 , 6 , 8 , Gary F. Mitchell , MD 1
01 April 2018
Impaired regulation of blood pressure upon standing can lead to adverse outcomes, including falls, syncope, and disorientation. Mean arterial pressure typically increases upon standing; however, an insufficient increase or a decline in mean arterial pressure upon standing may result in decreased cerebral perfusion. Orthostatic hypotension has been reported in older people with increased arterial stiffness, whereas the association between orthostatic change in mean arterial pressure and arterial stiffness in young-to-middle aged individuals has not been examined. We analyzed orthostatic blood pressure response and comprehensive hemodynamic data in 3205 participants (1693 [53%] women) in the Framingham Heart Study Third Generation cohort. Participants were predominantly middle-aged (mean age: 46±9 years). Arterial stiffness was assessed using carotid-femoral pulse wave velocity, forward pressure wave amplitude, and characteristic impedance of the aorta. Adjusting for standard cardiovascular disease risk factors, orthostatic change in mean arterial pressure (6.9±7.7 mm Hg) was inversely associated with carotid-femoral pulse wave velocity (partial correlation, r p = −0.084, P<0.0001), forward wave amplitude (r p = −0.129, P<0.0001), and characteristic impedance (r p = −0.094, P<0.0001). The negative relation between forward wave amplitude and change in mean arterial pressure on standing was accentuated in women (P=0.002 for sex interaction). Thus, higher aortic stiffness was associated with a blunted orthostatic increase in mean arterial pressure, even in middle age. The clinical implications of these findings warrant further study.