Objective To investigate the relationship between orthostatic hypotension (OH), orthostatic hypertension (OHT) and early arteriosclerosis indicators such as cervico-femoral pulse wave velocity (cfPWV), brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) in patients with essential hypertension.

Methods A total of 2 043 patients with essential hypertension who were untreated or had stopped taking antihypertensive drugs for more than one month in the hypertension clinic of zunyi Medical University Affiliated Hospital from January 2016 to September 2024 were selected. Based on the results of blood pressure changes within 3 minutes of standing, the subjects were divided into orthostatic normotension (ONT), OHT, and OH groups. The differences in clinical data among the three groups were compared. Multivariate logistic regression and restricted cubic spline (RCS) analyses were applied to evaluate the relationship between orthostatic blood pressure changes and early arterial stiffness indicators in hypertensive patients.

Results Among the ONT, OHT and OH groups, cfPWV showed an increasing trend (8.32±1.66) vs (8.95±2.32) vs (9.58±2.38) m/s, F=35.57, P＜0.001, baPWV also showed an increasing trend (1 570.90±276.38) vs (1 669.84±373.62) vs (1 829.37±362.35) cm/s, F=48.88, P＜0.001. There was no significant difference in ABI among the three groups (P＞0.05). Multivariate logistic regression analysis showed that after adjusted for confounding factors such as age and gender, compared with the ONT group, the OR (95%CI) for cfPWV＞10 m/s in the OHT and OH groups were 1.60 (1.08−2.37) and 1.67(1.05−2.67), and the OR (95%CI) for baPWV≥14 m/s were 2.17(1.41−3.33) and 4.64(1.64−13.11), respectively. The restricted cubic spline graph showed that there was a U shape relationship between the change in upright systolic blood pressure (ΔSBP) and the risk of cfPWV＞10 m/s and baPWV≥14 m/s (P for nonlinear=0.004, 0.001), and there was a negatively linear relationship between the change in upright diastolic blood pressure (ΔDBP) and the risk of cfPWV＞10 m/s (P for overall=0.012, P for nonlinear=0.057), while there was no significant correlation between ΔDBP and the risk of baPWV≥14 m/s (P for overall=0.621). Age str2.37) and 1.67(1.05−2.67), and the OR (95%CI) for baPWV≥14 m/s were 2.17(1.41−3.33) and 4.64(1.64−13.11), respectively. The restricted cubic spline graph showed that there was a U shape relationship between the change in upright systolic blood pressure (ΔSBP) and the risk of cfPWV＞10 m/s and baPWV≥14 m/s (P for nonlinear=0.004, 0.001), and there was a negatively linear relationship between the change in upright diastolic blood pressure (ΔDBP) and the risk of cfPWV＞10 m/s (P for overall=0.012, P for nonlinear=0.057), while there was no significant correlation between ΔDBP and the risk of baPWV≥14 m/s (P for overall=0.621). Age stratification analysis showed that OHT and OH were not associated with the risks of cfPWV＞10 m/s and baPWV≥14m/s in patients aged 44 and under (both P＞0.05), while OHT and OH were independently associated with the risks of cfPWV＞10 m/s and baPWV≥14 m/s in patients over 44 years old.

Conclusion OHT and OH are independent risk factors for increased cfPWV and baPWV in patients over 44 years old with essential hypertension. OHT and OH are not associated with the risk of atherosclerosis in patients aged 44 and under with essential hypertension.