Supine hypertension worrisome, measuring BP in noisy environment can be acceptable, accurate

Supine hypertension without seated hypertension was associated with risk of coronary heart disease (CHD), heart failure, stroke, fatal coronary heart disease, and all-cause mortality, a study found.

Researchers conducted a cohort study of 11,369 middle-aged adults using data from the Atherosclerosis Risk in Communities (ARIC) study to evaluate the association between supine hypertension, with and without seated hypertension, and CVD outcomes. Hypertension was defined systolic blood pressure of 130 mm Hg or greater or a diastolic blood pressure of 80 mm Hg or greater. Participants with a history of CHD, heart failure, or stroke were excluded. Data were analyzed from May 2023 through December 2024. Results were published online Jan. 22 in JAMA Cardiology.

Participants' mean age was 53.9 years, 55.7% were female, 25.1% were Black, and 74.9% were White. At baseline, 4,263 participants (37.5%) had supine hypertension. Among the 7,168 patients without seated hypertension, 16.4% (95% CI, 15.5% to 17.2%) had supine hypertension, and among the 4,201 patients with seated hypertension, 73.5% (95% CI, 72.2% to 74.8%) had supine hypertension.

Supine hypertension was associated with incident CHD (hazard ratio [HR], 1.60; 95% CI, 1.45 to 1.76), heart failure (HR, 1.83; 95% CI, 1.68 to 2.01), stroke (HR, 1.86; 95% CI, 1.63 to 2.13), fatal CHD (HR, 2.18; 95% CI, 1.84 to 2.59), and all-cause mortality (HR, 1.43; 95% CI, 1.35 to 1.52) during a median follow-up of 25 to 28 years. There were no meaningful differences by seated hypertension status, and results were similar with and without hypertension medication use.

Participants with supine hypertension alone had risks similar to those of participants with hypertension in both positions and significantly greater than those of participants with seated hypertension alone, with the exception of fatal CHD.

While blood pressure is normally autonomously controlled regardless of body position, autonomic impairment, venous insufficiency, and endothelial dysfunction may contribute to elevations in supine blood pressure, the study authors wrote, adding that pressure from a bed over a broader body surface area may shift body fluid volume. While further research is needed, “given the simplicity of performing a supine [blood pressure] in the clinic and the opportunity to detect occult hypertension, supine hypertension warrants greater attention,” they said.

Another recent study determined that measuring blood pressure in public or noisy settings does not affect readings, suggesting that public spaces can be used for mass screening programs.

Researchers randomized 108 adults to the order in which they had triplicate blood pressure measurements in a private quiet office, a noisy public space, and a noisy public space plus earplugs. The primary outcome was differences between the mean blood pressure values obtained in each setting. The results were published Jan. 28 by Annals of Internal Medicine.

Average noise levels were 37 decibels (dB) in the private quiet setting and 74 dB in the public setting. Mean systolic blood pressure readings were 128.9 mm Hg in private quiet, 128.3 mm Hg in public loud, and 129.0 mm Hg in public quiet, while diastolic blood pressure readings were 74.2 mm Hg, 75.9 mm Hg, and 75.7 mm Hg, respectively. Public-loud and public-quiet blood pressure readings had minimal, nonclinically important differences from private-quiet blood pressure readings, the study authors observed.

The results support mass hypertension screening programs in settings such as supermarkets, places of worship, and schools, according to the authors. While previous studies in pharmacies or work settings showed a difference in blood pressure readings, other factors in these environments may have caused elevated readings, they noted.