Supine Hypertension Linked to Higher Cardiovascular Risk, JAMA Study Finds

The researchers revealed that individuals with elevated supine blood pressure—regardless of their seated blood pressure levels—experience a higher hazard ratio (HR) for cardiovascular risk. This indicates that supine hypertension might be an even stronger indicator of cardiovascular disease (CVD) risk than seated hypertension alone.

The study noted that elevated blood pressure during sleep, known as nocturnal hypertension, is linked to a significant rise in the risk of cardiovascular disease and mortality. While seated blood pressure has long been used as a standard metric for hypertension diagnosis, Duc M. Giao, Harvard Medical School, Boston, Massachusetts, and colleagues aimed to examine the relationship between supine hypertension and cardiovascular disease outcomes, considering the status of hypertension treatment.

For this purpose, the researchers conducted a prospective cohort study using data from the Atherosclerosis Risk in Communities (ARIC) study, established in 1987. The study analyzed supine and seated blood pressure measurements in over 13,000 middle-aged adults. The study excluded participants with a history of coronary heart disease (CHD), heart failure, or stroke and followed them for 27 years to track CVD outcomes.

Supine hypertension was defined as a systolic blood pressure ≥130 or diastolic ≥80 mm Hg. Cox proportional hazard models were used to assess the relationship between supine hypertension, seated hypertension, and incidents of CHD, heart failure, stroke, fatal CHD, and all-cause mortality.

The study revealed the following findings:

• Among 11,369 participants without known cardiovascular disease, 16.4% without seated hypertension had supine hypertension, while 73.5% with seated hypertension had supine hypertension.
• Supine hypertension was linked to higher risks of incident CHD (HR, 1.60), heart failure (HR, 1.83), stroke (HR, 1.86), fatal CHD (HR, 2.18), and all-cause mortality (HR, 1.43) during a median follow-up of approximately 25.7 to 28.3 years.
• No meaningful differences in results were observed based on seated hypertension status or hypertension medication use.
• Participants with only supine hypertension showed similar risk associations to those with hypertension in both positions, with risks significantly higher than those with seated hypertension alone, except for fatal CHD.
• The hazard ratios for seated vs supine hypertension were lower for CHD (0.72), heart failure (0.72), stroke (0.66), and all-cause mortality (0.83).

In the cohort study conducted among middle-aged, community-dwelling adults, the authors found that supine hypertension is independently associated with an increased risk of cardiovascular disease events, regardless of medication use or seated hypertension. Notably, supine hypertension was linked to a higher risk of CVD events compared to seated hypertension.

"Future research should explore whether targeting and treating supine hypertension could potentially reduce the risk of CVD events, providing a more comprehensive approach to hypertension management, the researchers concluded.

Reference:

Giao DM, Col H, Larbi Kwapong F, et al. Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality. JAMA Cardiol. Published online January 22, 2025. doi:10.1001/jamacardio.2024.5213