Document Detail

Does orthostatic testing have any role in the evaluation of the young subject with mild hypertension?: an insight from the HARVEST study.
MedLine Citation:
PMID:  9160766     Owner:  NLM     Status:  MEDLINE    
The aim of the study was to assess the clinical significance of the blood pressure (BP) reaction to standing in 1029 stage I hypertensives. Office BP was measured six times in the supine position and six times after 2 min of standing. All subjects underwent 24-h ambulatory BP monitoring, and measurements of 24-h urinary epinephrine and norepinephrine excretion. Echocardiography was performed in 636 patients. With use of mixture analysis we could single out a population with abnormal diastolic BP response to standing (hyperreactors, n = 95). These subjects had a diastolic BP increase from lying to standing of >11 mm Hg. The other subjects were defined as normoreactors (n = 934). Office systolic BP was similar in the two groups. Diastolic BP was lower (91 +/- 6 mm Hg v 95 +/- 5 mm Hg, P < .0001) and heart rate was higher in the hyperreactors (77 +/- 10 beats/min v 75 +/- 9 beats/min, P = .004). After adjusting for age, gender, and smoking habits the statistical significance did not change. Adjusted 24-h systolic BP (P = .02) and diastolic BP (P = .02) were higher in the hyperreactors than in the normoreactors. Hyperreactors were characterized by higher cardiac index (3.2 +/- 0.8 L/min/m2 v 3.0 +/- 0.7 L/min/m2, P = .008 for adjusted values), lower total peripheral resistance (1420 +/- 330 dyne/sec/cm(-5) v 1600 +/- 380 dyne/sec/cm(-5), P = .003), and higher urinary norepinephrine output (114.9 +/- 80.3 microg/24 h v 90.6 +/- 78.5 microg/24 h, P = .03). Dimensional echocardiographic data and albumin excretion rate did not differ between the two groups. In conclusion, mixture analysis allowed us to identify a population of young mild hypertensives with exaggerated BP response to standing. Hyperreactors were characterized by higher whole-day BP and by a hyperkinetic hemodynamic pattern as a result of increased sympathetic tone.
O Vriz; G Soon; H Lu; A B Weder; C Canali; P Palatini
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hypertension     Volume:  10     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-07-11     Completed Date:  1997-07-11     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  546-51     Citation Subset:  IM; S    
Clinica Medica 1, University of Padova, Italy.
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MeSH Terms
Blood Pressure / physiology*
Blood Pressure Monitoring, Ambulatory / methods
Epinephrine / urine
Heart Rate
Hypertension / diagnosis*,  physiopathology
Hypotension, Orthostatic / diagnosis*,  physiopathology
Middle Aged
Norepinephrine / urine
Sympathetic Nervous System / physiology
Reg. No./Substance:
51-41-2/Norepinephrine; 51-43-4/Epinephrine

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