ORTOSTATIC CHANGES OF BLOOD PRESSURE DURING MAY MEASUREMENT MONTH INITIATIVE IN BULGARIA

Objective: The recent 2023 ESH Guidelines have recognized the clinical value of standing blood pressure (BP) measurement in the assessment of individuals with hypertension. Nevertheless, few populational data of orthostatic BP changes as part of hypertension screening programs exists. Design and method: In addition to the triplicate blood pressure measurement in a sitting position, during May Measurement Month initiative in Bulgaria in 2023 and 2024 we assessed the orthostatic changes of BP. After 1-3 minutes of standing three additional measurements was taken using validated automated devices with forearm supported at heart level. An exaggerated orthostatic pressor response (EOPR) was defined as a sustained increase in systolic blood pressure by at least 20 mmHg when changing position, orthostatic hypertension (OHyper) – as an EOPR associated with SBP of at least 140 mmHg and orthostatic hypotension (OHypo) as a drop of SBP> 20 mmHg within 3 minutes of active standing. Results: A total of 3051 participants were analyzed [mean age 60.7±16.2 years, men 42%, 58.5% with a history of arterial hypertension]. The mean sitting BP was 132.4/83.4 mmHg and slightly increase with standing – mean delta SBP 0.37±10 mmHg, delta DBP 0.78 ±14.6 mmHg. BP changes in standing position was observed in 2064 individuals (67.6%), the presence of OHypo in 96 (3.1%), OHyper - 95 (3.1%), and EOPR in 63 (2.1%). In patient group with arterial hypertension the predominant orthostatic reaction was OHypo, followed by OHyper and EOPR (28%, 15% and 9.4% respectively) with an opposite trend noticed in normotensives (9,8%, 22,4% and 15.4%, p<0,001). The age significantly affects the association - while orthostatic hypotension was more common among individuals over 65 years of age, regardless of hypertensive status, the mean age of patients with orthostatic hypertension was 63.1 and 42.2 years in the presence or absence of arterial hypertension, respectively. Conclusions: The present study clearly demonstrates the need of specific focus and additional mechanistic studies in individuals with an orthostatic hyperresponsiveness.