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(Hypertension. 1999;33:1123-1129.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Descriptive Epidemiology of Blood Pressure Response to Change in Body Position

The ARIC Study

Christopher J. Nardo; Lloyd E. Chambless; Kathleen C. Light; Wayne D. Rosamond; A. Richey Sharrett; Grethe S. Tell; Gerardo Heiss

From the Department of Epidemiology (C.J.N., W.D.R., G.H.) and the Collaborative Studies Coordinating Center (L.E.C.), School of Public Health, University of North Carolina, Chapel Hill; Department of Psychiatry (K.C.L.), School of Medicine, University of North Carolina, Chapel Hill; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.R.S.); and Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway (G.S.T.).

Correspondence and reprint requests to Gerardo Heiss, MD, PhD, Department of Epidemiology, UNC-CH School of Public Health, Suite 306, NationsBank Plaza, 137 E Franklin St, Chapel Hill, NC 27514. E-mail gerardo_heiss{at}unc.edu

Abstract—The epidemiology of a common measure of cardiovascular reactivity, the change in systolic blood pressure (SBP) from the supine to the standing position, is described in a cohort of 13 340 men and women aged 45 to 65 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. The distribution of SBP was found to be symmetrical and unimodal, with a mean value near zero (-0.45 mm Hg). The range of SBP was from -63.2 to 54.3 mm Hg, and the standard deviation was 10.8. Stratification of SBP by race and gender shows a slight shift in distribution toward higher values for black men and women. SBP was categorized into deciles. Participants in the top 30% and bottom 30% of the distribution were compared with individuals in the middle 40% of the distribution, who had little or no change in SBP on standing. Participants in the bottom 30% (ie, SBP decreased on standing) were significantly older, had a greater prevalence of hypertension and peripheral vascular disease, had higher values of SBP, and had more cigarette-years of smoking. Among participants in the top 30% (ie, SBP increased on standing), a significantly larger proportion were black, mean seated SBP was higher, and the predicted risk of developing coronary heart disease after 8 years was greater. The response of SBP to change in posture showed considerable variability in a population sample of middle-aged adults. Cardiovascular morbidity, sociodemographic factors, and cigarette smoking were associated with the magnitude and direction of the postural change.

Key Words: blood pressure • cardiovascular reactivity • epidemiology

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