Elsevier

Mayo Clinic Proceedings

Volume 78, Issue 8, August 2003, Pages 951-958
Mayo Clinic Proceedings

Original Article
Positional Change in Blood Pressure and 8-Year Risk of Hypertension: The CARDIA Study

https://doi.org/10.4065/78.8.951Get rights and content

Objective:

To assess the relationship between positional blood pressure change and 8-year incidence of hypertension in a biracial cohort of young adults.

Subjects and Methods:

Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study with complete data from year 2 (1987-1988), year 5 (1990-1991), year 7 (1992-1993), and year 10 (1995-1996) examinations were included (N=2781). Participants were classified into 3 groups based on their year 2 systolic blood pressure response to standing: drop, a decrease in systolic blood pressure of more than 5 mm Hg; same, a change of between –5 and +5 mm Hg; and rise, more than 5-mm Hg increase.

Results:

The number of participants in each group was as follows: drop, 741; same, 1590; and rise, 450. The 8-year incidence of hypertension was 8.4% in the drop group, 6.8% in the same group, and 12.4% in the rise group (P<.001). Adjusted odds ratios for developing hypertension during the follow-up period in the rise group vs the same group were as follows: in black men, 2.85 (95% confidence interval [CI], 1.43-5.69), in black women, 2.47 (95% CI, 1.19-5.11), in white men, 2.17 (95% CI, 1.00-4.73), and in white women, 4.74 (95% CI, 1.11-20.30).

Conclusions:

A greater than 5-mm Hg increase in blood pressure on standing identified a group of young adults at increased risk of developing hypertension within 8 years. These findings support a physiologic link between sympathetic nervous system reactivity and risk of hypertension in young adults.

Section snippets

SUBJECTS AND METHODS

The study population was derived from 5115 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who were between 18 and 30 years of age in 1985-1986 (year 0), at which time they underwent an initial interview and measurement of clinical factors associated with the development of coronary artery disease. The methods of these measurements have been published previously.7 Among the original 5115 CARDIA participants from year 0, 2781 (54%) had complete data from

RESULTS

The sociodemographic and clinical characteristics of participants in each of the 3 standing blood pressure groups are shown in Table 1; 26.6% of participants were in the drop group, 57.2% in the same group, and 16.2% in the rise group. Small but significant differences were noted in the distribution by sex and race groups. Twenty percent of black men and 19% of white men were in the rise group compared with 15% of black women and 13% of white women (P=.004 for race-sex distribution within the

DISCUSSION

We found a clear association between increase in blood pressure on standing and 8-year incidence of hypertension, before and after adjustment for potentially confounding variables. This association was present in all sex-race groups in our biracial cohort of young adults, although it was of only borderline significance in white men. Although numerous studies have shown a strong association between resting blood pressure and future risk of developing hyper-tension,9, 10, 11, 12 few previous

CONCLUSIONS

An increase in blood pressure on standing of more than 5 mm Hg in our biracial cohort of young adults identified a group at increased risk of developing hypertension over the subsequent 8 years. Given the relatively low prevalence of hypertension in the CARDIA population to date and therefore the low positive predictive value for blood pressure change on standing, longer follow-up is needed for a better assessment of the value of this clinical sign as a predictive risk factor for hypertension.

REFERENCES (33)

  • GR Cutter et al.

    Cardiovascular risk factors in young adults: the CARDIA baseline monograph

    Control Clin Trials

    (1991)
  • WW Cook et al.

    Proposed hostility and pharisaic-virtue scales for the MMPI

    J Appl Psychol

    (1954)
  • RS Paffenbarger et al.

    Chronic disease in former college students, VIII: characteristics in youth predisposing to hypertension in later years

    Am J Epidemiol

    (1968)
  • SM Shetterly et al.

    Patterns and predictors of hypertension incidence among Hispanics and non-Hispanic whites: the San Luis Valley Diabetes Study

    J Hypertens

    (1994)
  • WS Post et al.

    Hemodynamic predictors of incident hypertension: the Framingham Heart Study

    Hypertension

    (1994)
  • A Himmelmann et al.

    Predictors of blood pressure and left ventricular mass in the young: the Hypertension in Pregnancy Offspring Study

    Am J Hypertens

    (1994)
  • Cited by (72)

    • Orthostatic hypertension as a risk factor for age-related macular degeneration: Evidence from the Irish longitudinal study on ageing

      2018, Experimental Gerontology
      Citation Excerpt :

      OHTN may represent pre-hypertension (Kario, 2013). In the CARDIA study (ages18–30 yrs), those who were normotensive but had OHTN, had increased odds of developing hypertension during an 8 year follow-up (Thomas et al., 2003). In the HARVEST study, diastolic OHTN in those with stage 1 hypertension was associated with higher daytime BP (Vriz et al., 1997).

    View all citing articles on Scopus

    This work was supported by grants N01HC-48047, N01HC-48048, N01HC-48049, N01HC-48050, and N01HC-95095 from the National Heart, Lung, and Blood Institute.

    View full text