Abstract 15714: Association of Obesity With Orthostatic Hypertension

Introduction: Orthostatic hypertension (OHT) is variably defined, poorly understood, multifactorial but may contribute to target organ damage. Increase systolic blood pressure (SBP) over 10 mmHg from supine to standing may identify OHT with increased baseline sympathetic nervous system (SNS) and renin angiotensin aldosterone system (RAAS) activation. Diabetes, advanced age, and neurological disorders appear to predispose to OHT and this has not been characterized in obese patients. Hypothesis: RAAS and SNS activation is well recognized in obesity. Routine orthostatic BP measurement in obese patients may identify OHT. Methods: Between 5.2021 to 5.2022, we screened obese patients presenting to University of Missouri -Columbia cardiology clinic for OHT. Supine BP was obtained after 5 minutes of rest and standing BP measured 3 minutes after standing. BMI was estimated from height and weight obtained routinely during same clinic visit. Risk factors were estimated from medical records. Results: OHT was identified in 30 patients (Males 7, females 23) with average age 55.1 ± 17.6 years. Weight was 128.6 ± 27.4 kg, BMI 47.9 ± 9.9 kg/m 2 . Supine systolic and diastolic BP were 131.9 ± 15.9 and 78.3 ± 8.4 mmHg. On standing, systolic and diastolic BP increased to 155.7 ± 19.5 and 92.5 ± 13.1 mmHg. Standing resulted in systolic and diastolic BP increase of 23.8 and 14.2 mmHg, respectively. Hypertension (n= 23, 77%), depression (15, 50%) diabetes (12, 40%), asthma (9, 30%), sleep apnea (12, 40%), heart failure (7, 23%), anxiety - post traumatic stress disorder (5, 17%), chronic obstructive lung disease (3, 10%) and atrial fibrillation (3, 10%) were common associations. Acute increase in BP may contribute to palpitation and dyspnea on standing reported in 5 (17%) of the OHT patients. Conclusions: Orthostatic hypertension is prevalent in obese patients and underdiagnosed during clinic visits. Severe obesity predisposes especially women to significant standing blood pressure increase that may cause symptoms and target organ damage. Routine Orthostatic BP Screening during clinic visits especially in obese patients is required to identify orthostatic hypertension, to optimize outcomes with appropriate lifestyle interventions and medications.