If standing raises your blood pressure, it could be a red flag for a heart attack

DALLAS, Texas — Standing up and moving around may be good suggestions to keep you active, but if just getting to your feet sends your blood pressure soaring, you may be at risk for a heart attack.

Researchers with the American Heart Association say young and middle-aged individuals who see their blood pressure rise quickly upon standing are almost twice as likely to suffer a heart attack, stroke, or other major cardiovascular event later in life. The sudden jump could become an easy test to identify who is most at risk for heart disease and get them the care they need sooner.

According to the CDC, nearly half of all adults in the United States have hypertension (47%) — that’s approximately 116 million people. High blood pressure affects around two in five people globally and health experts consider it the world’s leading preventable cause of death.

Statistics suggest people with high blood pressure during middle age are five times more likely to have brain cognitive impairment and are twice as likely to end up with dementia or Alzheimer’s disease when they get older. Typically, systolic blood pressure falls slightly when you stand up. This is the top number in a blood pressure measurement which reveals the pressure exerted when the heart beats. This sparked the researchers’ curiosity to find out whether the opposite response means people are at higher risk of cardiac arrest and stroke.

Blood pressure can jump by an alarming rate when standing

During the study, the researchers looked at health records on 1,207 Italians who took part in the HARVEST study, which began in 1990. This group included adults between 18 and 45 years-old with untreated stage one hypertension — which is systolic pressure of between 140 and 159 mmHg or a diastolic pressure of 90 to 100 mmHg.

None of them took blood pressure-lowering medication before entering the study. Doctors also deemed each person to be at low risk of heart attack and stroke. Additionally, no one had diabetes, kidney impairment, or any other cardiovascular diseases.

Study authors took six blood pressure measurements from each participant in various physical positions, including while lying down and after standing up. The 120 participants with the highest rise in blood pressure upon standing averaged an 11.4 mmHg increase and everyone in this group had a jump of at least 6.5 mmHg.

The remaining participants averaged a 3.8 mmHg drop in systolic blood pressure upon standing.

This doesn’t mean you’re less healthy than other people

The researchers compared heart disease risk factors, laboratory measurements, and the occurrence of major cardiovascular events including heart attack, heart-related chest pain, stroke, aneurysm of the aortic artery, clogged peripheral arteries, and chronic kidney disease among participants in both groups. In some cases, the team also assessed the development of atrial fibrillation, an arrhythmia that is a major risk factor for stroke.

During the follow-up period, which averaged 17 years, 105 major cardiovascular events took place. The most common were heart attack, heart-related chest pain, and stroke.

The 10 percent of participants with the fastest rise in blood pressure were almost twice as likely as others to experience a major cardiovascular event. During their initial examination, researchers note that these participants did not have a higher risk of major cardiovascular events, apart from their abnormal blood pressure response to standing.

People in this group were also more likely to be smokers but were not more obese or less active than other participants. They also did not have a family history of heart problems that was drastically different from the healthier group.

In fact, their cholesterol levels were lower than other participants and they had lower blood pressure levels while lying down. After adjusting for average blood pressure taken over 24 hours, a heightened blood pressure response to standing remained an independent predictor of adverse heart events or stroke.

“The results of the study confirmed our initial hypothesis – a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure. We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run,” says lead study author Professor Paolo Palatini in a media release.

Could this be a reaction to stress?

In a subset of 630 participants who had stress hormones measured from 24-hour urine samples, the epinephrine/creatinine ratio was higher in the people with a rise in standing blood pressure compared to those whose standing blood pressure did not rise. Epinephrine levels are an estimate of the effect of stressful stimuli over a 24-hour period.

This suggests the people who had a blood pressure jump when standing up may have more of a fight-or-flight response to stressors, which causes a rise in blood pressure. Prof. Palatini adds the findings suggest blood pressure while standing should become a standard measure so doctors can properly tailor their treatments for people at higher risk of heart disease.

“Epinephrine levels are an estimate of the global effect of stressful stimuli over the 24 hours. This suggests that those with the highest blood pressure when standing may have an increased sympathetic response [the fight-or-flight response] to stressors,” Palatini continues. “Overall, this causes an increase in average blood pressure.”

“The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood-pressure-lowering therapy may be considered for people with an elevated [hyperreactor] blood pressure response to standing.”

The findings are published in the American Heart Association’s journal Hypertension.

South West News Service writer Gwyn Wright contributed to this report.

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