© 2011 by the American Journal of Hypertension, Ltd. In patients with chronotropic incompetence, heart rate may not increase upon standing, and they may experience orthostatic hypotension (OH). Therefore, the bias caused by the inclusion of obese individuals did not seem to relevantly alter the results of the study. Systolic and diastolic blood pressure was the highest in supine … of SBP = 15mmHg and s.d. Matrix showing the results of the six comparison between mean systolic or diastolic blood pressures as measured in three body positions (univariate analysis). The last results of the study that may have clinical relevance are the highest rates of large differences that were always observed at the first measurement, in the comparisons by position, and between the first and third measurements, in the comparisons by order. Discussion. of DBP = 10mmHg, regardless of the position. d'Annunzio” of Chieti. It is widely accepted that diastolic pressures while sitting are higher than when a patient is supine by as much as 5 mmHg. True or False 8. On the other side, our findings strongly support current recommendations which suggest that at least two measurements of BP (within a few minutes) always be taken, as the proportion of subjects showing a large (≥10mmHg) BP difference between one and another measurement in the same body position was as large as 30–32% for SBP and 15–20% for DBP. 31.van Dijk JG, Tjon-A-Tsien AM, Kamzoul BA, Kramer CG, Lemkes HH. The mean age of the 250 hypertensive participants was 66.3 ± 13.4 years; males were 44.4%, obese 28.8% (mean BMI = 28.3 ± 4.0; mean arm circumference = 29.1 ± 2.7cm). http://www.medicinenet.com/script/main/art.asp?articlekey=17237. To explore whether the appearance of large differences could be associated with the order of the measurement, both comparisons by position and by order were repeated using order categories (Table 3). In addition, they said diastolic blood pressure is 1-5 mmHg higher when measured supine vs seated 8 . It’s a small step to take to save your health and possibly your life. Relationship between office blood pressure (BP) in the supine position and abulatory blood pressure recorded during the awake hours in 168 patients with a history of mild to moderate essential hypertension. 14.Keir DL, Wise BA, Krebs C, Kelley-Arney C. 16.Netea RT, Lenders JW, Smits P, Thien T. 17.Sala C, Santin E, Rescaldani M, Cuspidi C, Magrini F. 19.Belghazi J, El Feghali R, Moussalem T, Rejdych M, Asmar R. 20.Coleman A, Steel S, Freeman P, de Greeff A, Shennan A. Your position during a blood pressure check can influence your readings. Related: Surprising causes of high blood pressure, simple strategies to manage hypertension. The main aim of the study was to detect a clinically relevant variation in SBP and DBP measurements in three different positions. As compared with supine position, the SBP measured in Fowler's and sitting positions decreased of 1.1 and 2.0mmHg, respectively (both P < 0.05). The picture is further complicated by the frequent use in routine clinical practice of positions that are intermediate between supine and sitting, such as Fowler's position, in which the patients rest in their bed in a partial sitting position.1073.11,12 Fowler's position is commonly used to facilitate breathing and eventually reduce abdominal pain in immobilized subjects and/or patients with respiratory diseases or after surgery, but it may also be used in other patients just to relax abdominal muscles.11,13,–15. Second, it has been documented that comorbidities such as autonomic dysfunction in the aged, diabetic neuropathy, and parkinsonism, and antihypertensive agents such as β-blockaders and diuretics may enhance the difference of BP by body position and may thus confound the results of the study.31 However, we repeated all univariate (and multivariate) analyses stratifying (adjusting) for use of diuretics and β-blockers, with no relevant variation in the results (data not shown). Quantifying random variability in BP measurements may be important to verify whether it may confound the association between BP and body position, and whether more than one recording at each BP measurement is really needed. To investigate the degree of random variation in BP, the same approach was used to compute the percentage of subjects with large differences in BP according to the order of the measurement within each position. In example, a large “random” variation was detected if, in one of the three supine position measurements, the SBP (or DBP) of one subject was 140mmHg in the first (or second) measurement and <131 or >149mmHg in the second (or third) measurement. By contrast, DBP increased of 1.8 and 2.9mmHg, respectively (both P < 0.001). 22.Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Blood pressure is higher in the supine position that in the standing position. We arbitrarily assumed 4mmHg as the minimum BP mean difference being clinically relevant, and computed two sample sizes separately for SBP and DBP using the following assumptions: α = 0.05; β = 0.20; difference between Fowler's BP and other positions BP = 4mmHg; s.d. Hydrostatic effects are the most likely cause of the drop in blood pressure of left arm in right lateral position. pressure was inflated quickly to a pressure about Male heart rate while supine (60 ± 4 bpm) 30 mm Hg higher than average systolic pressure was significantly lower (p < 0.05) than when expected for the subject. 27.Netea RT, Bijlstra PJ, Lenders JW, Smits P, Thien T. 29.Kato T, Kikuya M, Ohkubo T, Satoh M, Hara A, Obara T, Metoki H, Asayama K, Hirose T, Inoue R, Kanno A, Totsune K, Hoshi H, Satoh H, Imai Y. We repeated all analyses stratifying for obesity, and observed very similar results for DBP, whereas obese subjects showed a more pronounced variability in SBP as compared to nonobese. Sample size calculation. Therefore, the blood volume in the thoracic (central venous) compartment as blood volume shift away from the legs. The differences in either SBP and DBP according to the position have been initially investigated using Wilcoxon-matched-pairs signed-ranks test, separately for each comparison. 32.van der Steen MS, Pleijers AM, Lenders JW, Thien T. Oxford University Press is a department of the University of Oxford. 2.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JLJr, Jones DW, Materson BJ, Oparil S, Wright JTJr, Roccella EJ. Therefore, in the clinical management of hypertensive subjects, if BP is measured before therapy in one position and after therapy in another position, the clinician may opt for imprecise or incorrect therapeutic strategies in a relevant proportion of subjects. Both models were set as repeated regression analyses, using patient's id as the cluster level, and fitted assuming an exchangeable correlation structure, with robust standard errors (based upon sandwich estimator).22 All recorded patient's variables (age, gender, BMI, heart rate, arm circumference, number of prescribed drugs/day) were included in the models a priori, regardless of their statistical significance. Our heart need to pump for supplying blood to brain. When a standing person suddenly changes to the supine position, gravity no longer causes a shift in blood volume from the thoracic compartment to the legs and feet. One of these, a … Although we cannot be sure that the duplication of BP measurement is enough to overcome BP variations across recordings, taking the mean value between two measurements reduces the possibility of a large measurement error or a large random variation. We performed a cross-sectional study to compare BP values obtained in supine, sitting, and Fowler's positions in essential hypertensive subjects. Specific tables were created containing a computer generated random sequence of each position, and a different random table was used for each patient. Exercise intervention to Normalize blood pressure and nocturnal Dipping in HyperTensive patients (END-HT): protocol of a randomized controlled trial, Risk of Incident Hypertension According to Physical Activity and Temporal Changes in Weight, Salt intake, aldosterone secretion and obesity: role in the pathogenesis of resistant hypertension, Renal sodium handling: perspective on adaptation to clinical practice, Associations between Social Determinants and Hypertension, Stage 2 Hypertension and Controlled Blood Pressure among Men and Women in the US, http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf, http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm, Receive exclusive offers and updates from Oxford Academic. Floaters: Home remedies and exercise volume shift away from the legs position could result different!, current guidelines should consider to add a mention that recording BP in one or position... 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