Supine Blood Pressure Readings May Reveal Hidden Health Risks

By Jonathan Springston, Editor, Relias Media

Asking patients to lie down to record blood pressure measurements might help clinicians learn much more about heart health beyond whether someone is hypertensive.

Researchers recently examined blood pressure data collected during the long-running Atherosclerosis Risk in Communities (ARIC) Study. For this analysis, there were 11,369 participants, excluding those with a history of stroke, heart disease, or heart failure; 56% were women; 25% were Black; the average age was 54 years; and the median follow-up was 25 to 28 years. ARIC investigators measured blood pressure for all participants, both while participants were seated and lying down.

In this most recent analysis, researchers split the information into four groups: a cohort of participants who recorded normal blood pressure when seated and lying down, a cohort that recorded high blood pressure only while sitting, a cohort that recorded high blood pressure only while lying down, and a cohort that recorded high blood pressure in both positions. Normal blood pressure was considered a systolic reading of lower than 120 mmHg and a diastolic reading lower than 80 mmHg.

Over the follow-up period, participants with normal blood pressure in both positions were at the lowest risk for adverse events. Participants with high blood pressure in both positions were at highest risk. Compared to participants who recorded normal readings in both positions, those with supine-only high blood pressure had a 53% higher risk of coronary heart disease, 51% higher risk of heart failure, 62% higher risk for stroke, 78% higher risk of fatal coronary heart disease, and 34% higher risk of death from all causes.

These researchers presented their findings on Sept. 9 during the American Heart Association Hypertension Scientific Sessions. One of the investigators, Stephen Juraschek, MD, PhD, suggested supine blood pressure measurements could be a way to uncover hypertension and associated health risks. "I do think this is a simple enough assessment that people could be empowered to check on their own, and people could use it in screening as well,” he offered.

However, there are a few caveats about these findings. First, this work has not been published yet in a peer-reviewed journal. Second, on the initial measurement, patients were supine for nearly 20 minutes, longer than usual primary care visits. Finally, these researchers did not design their analysis to consider the explanations for varied readings.

Juraschek and colleagues did call for other investigators to conduct a clinical trial to study supine hypertension screening and explore these questions further.

For more on this and related subjects, be sure to read the latest issues of Clinical Cardiology Alert.