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Purpose <p>Supine hypertension is prevalent but underdiagnosed among older adults, and its relationship with cardiovascular risk in adults aged ≥ 65 years remains unclear. This study aims to investigate the association between major adverse cardiovascular events (MACEs) and supine hypertension, stratified by hypertension treatment status.</p> Methods <p>Community-dwelling adults aged 65 years and older were enrolled. Supine hypertension was defined as supine systolic blood pressure (SBP) ≥ 140 or diastolic blood pressure (DBP) ≥ 90 mm Hg, while seated hypertension was defined as seated SBP ≥ 140 or DBP ≥ 90 mm Hg. The primary outcomes were MACEs, including nonfatal stroke, nonfatal myocardial infarction, and all-cause death.</p> Results <p>Among 3290 participants (mean age 71.4 years, 43.5% male), 345 MACEs occurred over a median follow-up of 6.4 years. Supine hypertension was present in 49.9% of participants, and 16.7% of participants had isolated supine hypertension. 73.2% of the participants with seated hypertension had supine hypertension. Supine hypertension was associated with an increased risk of MACEs (hazard ratio [HR], 1.43; 95%CI 1.14–1.80). Results remained consistent even after stratification by antihypertensive medication use. Participants with isolated supine hypertension exhibited a significantly higher risk of MACEs (HR, 1.39 vs. 1.18) and stroke (HR, 1.92 vs. 1.83) compared to those with isolated seated hypertension. Additionally, SBP change between supine and seated positions was associated with increased mortality risk (HR,1.01; 95%CI 1.00–1.02).</p> Conclusion <p>Isolated supine hypertension demonstrated a higher HR for MACEs and stroke than isolated seated hypertension. The postural SBP difference was associated with increased mortality risk in older adults.</p>

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Association of supine versus seated hypertension with cardiovascular events in older adults

  • 期刊论文

  • 发表日期：

    2026年1月16日

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  • Jingjing Hou,
  • Jieying Shi,
  • Song Zhao,
  • Shikai Yu,
  • Bo Wang,
  • Yi Zhang

摘要

Purpose

Supine hypertension is prevalent but underdiagnosed among older adults, and its relationship with cardiovascular risk in adults aged ≥ 65 years remains unclear. This study aims to investigate the association between major adverse cardiovascular events (MACEs) and supine hypertension, stratified by hypertension treatment status.

Methods

Community-dwelling adults aged 65 years and older were enrolled. Supine hypertension was defined as supine systolic blood pressure (SBP) ≥ 140 or diastolic blood pressure (DBP) ≥ 90 mm Hg, while seated hypertension was defined as seated SBP ≥ 140 or DBP ≥ 90 mm Hg. The primary outcomes were MACEs, including nonfatal stroke, nonfatal myocardial infarction, and all-cause death.

Results

Among 3290 participants (mean age 71.4 years, 43.5% male), 345 MACEs occurred over a median follow-up of 6.4 years. Supine hypertension was present in 49.9% of participants, and 16.7% of participants had isolated supine hypertension. 73.2% of the participants with seated hypertension had supine hypertension. Supine hypertension was associated with an increased risk of MACEs (hazard ratio [HR], 1.43; 95%CI 1.14–1.80). Results remained consistent even after stratification by antihypertensive medication use. Participants with isolated supine hypertension exhibited a significantly higher risk of MACEs (HR, 1.39 vs. 1.18) and stroke (HR, 1.92 vs. 1.83) compared to those with isolated seated hypertension. Additionally, SBP change between supine and seated positions was associated with increased mortality risk (HR,1.01; 95%CI 1.00–1.02).

Conclusion

Isolated supine hypertension demonstrated a higher HR for MACEs and stroke than isolated seated hypertension. The postural SBP difference was associated with increased mortality risk in older adults.