Clujul Medical - Iuliu Haţieganu

Clujul Medical 2006 vol. LXXX - nr. 1
The orthostatic hypertensive reaction in a hypertensive
population from ambulatory
R.A. TRÎMBIŢAŞ, N. OLINIC
Summary
The orthostatic hypertensive reaction is defined as the increase with at least 10
mmHg in the systolic blood pressure when changing the posture from decubitus to
orthostatism. Unlike orthostatic hypotension, it is a less studied phenomenon, only
recently taken into account. The aim of this study was to establish the prevalence of the
orthostatic hypertensive reaction in a hypertensive population from ambulatory and to
emphasise some clinical, electrocardiographic, echocardiographic and carotid
ultrasonographic features of these patients. A number of 1000 hypertensives with
systolic blood pressures ≥160 mmHg and/or diastolic blood pressures ≥100 mmHg were
initially considered; only 707 remained in the follow-up. The blood pressure was
measured bilaterally in dorsal decubitus, then immediatly after standing and after 3
minutes of orhostatism. An electrocardiogram, an echocardiography and a carotid
ultrasonography were undertaken in all the 707 patients. This study is an
observational, descriptive and cross-sectional one.
The prevalence of the orthostatic hypertensive reaction in the studied
population was an unexpected high one (21.46%), especially comparing to the
prevalence of the orthostatic hypotension (12.6%). Aproximatively a half of the subjects
had an acute cornary syndrome (49%) or stroke (56.9% ) in their hisory. Left ventricular
hypertrophy was encountered in 62.7% on the electrocardiogram and in 72.5% on the
echocardiogram; more than a half of the patients with ultrasonographic left ventricular
hypertrophy had an asymmetric septal hypertrophy. An increased (more than 0.8 mm)
carotid intima media thickness was observed in 58.8% of the patients with orthostatic
hypertensive reaction. We can conclude that in patients with moderate or severe
primary hypertension the orthostatic hypertensive reaction is at least as frequent as the
orthostatic hypotension; the phenomenon is associated with a high rate of acute
atherothrombotic events in the clinical history and a high prevalence of markers of
target organ damage.
Key words: hypertension, orthostatism, acute atherotrombotic events.
59