Kharraziha Isabella, Memarian Ensieh, Ekblom Örjan, Gottsäter Anders, Engström Gunnar, Hamrefors Viktor
Department of Clinical Sciences, Lund University, Malmö, Sweden.
Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
J Hum Hypertens. 2025 May 5. doi: 10.1038/s41371-025-01022-8.
An abnormal blood pressure (BP) response on standing is associated with atherosclerotic cardiovascular disease (CVD). The role of physical activity (PA) on orthostatic BP-reactions and its relation to subclinical atherosclerosis is unclear. We aimed to assess the association between PA and orthostatic BP-reactions, and whether PA modifies the relationship between orthostatic BP-reactions and subclinical atherosclerosis. A total of 5,396 middle aged subjects from the population-based SCAPIS-study were included. Associations between orthostatic BP-response and accelerometer-derived PA were studied using linear regression. Interaction analyses were performed to study modifying effects of PA on the relationship between orthostatic BP-response and subclinical coronary atherosclerosis, assessed by coronary artery calcium score (CACS). Moderate to vigorous PA (MVPA) was associated with less pronounced orthostatic systolic BP (SBP) increase but more pronounced orthostatic diastolic BP increase after adjusting for age, sex, total wear time, proportion weekend days and season (Beta per 1%-increase(mmHg):0.12; p = <0.01 and -0.06; p = 0.02, respectively). Subjects with high MVPA were less likely to have orthostatic hypertension (OHTN), but more likely to have orthostatic hypotension (OH; p = 0.002 for both). Individuals with higher CACS were more likely to have OH (p = 0.041) but not OHTN (p = 0.276). There were no interactions of PA on the association between orthostatic BP-response and CACS. In conclusion, physically active middle-aged individuals are less likely to show inappropriate SBP-increase upon standing, but more likely to have excessive SBP-decrease. PA does not modify the association between orthostatic BP-response and subclinical atherosclerosis. The relationship between PA, orthostatic BP and CVD is likely to be complex.
站立时异常的血压（BP）反应与动脉粥样硬化性心血管疾病（CVD）相关。体力活动（PA）对直立性血压反应的作用及其与亚临床动脉粥样硬化的关系尚不清楚。我们旨在评估PA与直立性血压反应之间的关联，以及PA是否会改变直立性血压反应与亚临床动脉粥样硬化之间的关系。纳入了基于人群的SCAPIS研究中的5396名中年受试者。使用线性回归研究直立性血压反应与加速度计测量的PA之间的关联。进行交互分析以研究PA对直立性血压反应与亚临床冠状动脉粥样硬化之间关系的调节作用，通过冠状动脉钙化评分（CACS）进行评估。在调整年龄、性别、总佩戴时间、周末天数比例和季节后，中度至剧烈PA（MVPA）与直立性收缩压（SBP）升高不明显相关，但与直立性舒张压升高更明显相关（每增加1%的β值（mmHg）：分别为0.12；p <0.01和-0.06；p =0.02）。MVPA高的受试者患直立性高血压（OHTN）的可能性较小，但患直立性低血压（OH）的可能性较大（两者p均=0.002）。CACS较高的个体患OH的可能性较大（p =0.041），但患OHTN的可能性不大（p =0.276）。PA对直立性血压反应与CACS之间的关联没有交互作用。总之，体力活动的中年个体站立时出现不适当SBP升高的可能性较小，但出现SBP过度下降的可能性较大。PA不会改变直立性血压反应与亚临床动脉粥样硬化之间的关联。PA、直立性血压与CVD之间的关系可能很复杂。
