Standing Blood Pressure better tool for Diagnosing Hypertension

A recent ground-breaking study revealed the significance of standing blood pressure measurement and found that standing BP, alone or in combination with seated BP, outperformed seated BP alone in diagnosing hypertension in adults. The study results were published in the journal Scientific Reports.

Hypertension (HTN) is a prevalent cardiovascular condition, and its accurate diagnosis is of paramount importance. Current guidelines recommend measuring blood pressure (BP) in a seated position during screenings for HTN. However, the accuracy of seated BP measurements in detecting high BP is limited. To address this issue, a cross-sectional study was conducted to assess the incremental value of standing BP in the diagnosis of HTN.

The study enrolled adults without known cardiovascular disease, HTN, or BP medication use. Seated, standing, and 24-hour ambulatory blood pressure measurements (ABPM) were obtained. The presence of HTN was defined according to the 2017 ACC/AHA and the 2023 ESH HTN guidelines, based on ABPM criteria. The diagnostic accuracy of seated and standing BP was evaluated using the area under the receiver-operating-characteristic curve (AUROC). The sensitivity and specificity of standing BP were assessed using cutoffs derived from Youden's Index, while seated BP was evaluated with cutoffs of 130/80 mmHg and 140/90 mmHg.

Findings:

• Among the 125 participants with a mean age of 49 ± 17 years; 62%  were female; 24% were Black.
• Among these, 33.6% had HTN.
• The Sensitivity and specificity of seated systolic BP (SBP) were 43% and 92%, respectively.
• The cutoffs determined by Youden's Index for standing SBP and diastolic BP (DBP) were 124/81 mmHg following the 2017 ACC/AHA HTN guidelines, and 123.5/83.5 mmHg based on the 2023 ESH HTN guidelines.
• The sensitivity and specificity of standing SBP were 71% and 67%, respectively.
• Standing SBP showed a significantly higher AUROC (0.81 [0.71–0.92]) than that of seated SBP (0.70 [0.49–0.91]) when HTN was defined as an average 24-hour SBP of 125 mmHg or higher.
• Additionally, when standing BP was added to seated BP, the combined approach (AUROC 0.80 [0.68–0.92]) improved the detection of HTN compared to seated BP alone.
• The patterns showed consistency for both the 2017 ACC/AHA and the 2023 ESH definitions for HTN.

Thus, results from the present study underscore the significance of standing BP, whether assessed independently or in combination with seated BP, in the diagnosis of HTN in adults. The findings demonstrate that standing BP outperforms seated BP in HTN diagnosis and offers valuable insights into refining the diagnostic process for this prevalent cardiovascular condition.

Further reading: Giacona, J.M., Kositanurit, W., Wang, J. et al. Utility of standing office blood pressure in detecting hypertension in healthy adults. Sci Rep 13, 15572 (2023). https://doi.org/10.1038/s41598-023-42297-6