AUTHOR=Cooper Leroy L. , Rong Jian , Maillard Pauline , Beiser Alexa , Hamburg Naomi M. , Larson Martin G. , DeCarli Charles , Vasan Ramachandran S. , Seshadri Sudha , Mitchell Gary F. 

TITLE=Relations of postural change in blood pressure with hypertension-mediated organ damage in middle-aged adults of the Framingham heart study: A cross-sectional study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1013876

DOI=10.3389/fcvm.2022.1013876

ISSN=2297-055X

ABSTRACT=Background: Dysregulation of compensatory mechanisms to regulate blood pressure (BP) upon postural change is a phenotype of BP variability and an emerging risk factor for cardiovascular outcomes. 
Methods: We assessed postural change in BP (starting 2 minutes after standing from a supine position), carotid-femoral pulse wave velocity (cfPWV), and markers of hypertension-mediated organ damage (HMOD) in the heart, kidney, and brain in Framingham Third Generation, Omni-2, and New Offspring Spouse Cohort participants. We related vascular measures (postural change in BP measures and cfPWV) with HMOD in 3495 participants (mean age 47 years, 53% women) using multivariable logistic and linear regression models. 
Results: In multivariable-adjusted models, we did not observe significant associations of vascular measures with presence of left ventricular hypertrophy, albuminuria, covert brain infarcts, or white matter hyperintensities (Bonferroni-adjusted P values >0.05/20>0.0025). In multivariable models, greater cfPWV (est. β=0.11±0.03; P<0.001), but not postural change in BP measures (Bonferroni-adjusted P values>0.05/20>0.0025), was associated with higher white matter free water using brain magnetic resonance imaging. In multivariable models, greater postural change in pulse pressure was associated with higher urinary albumin-creatinine ratio (est. β=0.07±0.02; P<0.001). No other postural change in BP measure was associated with urinary albumin-creatinine ratio (Bonferroni-adjusted P values>0.05/20>0.0025). In sex-specific analyses, higher cfPWV was associated with higher urinary albumin-creatinine ratio in men (est. β: 0.11±0.04; P=0.002) but not in women (est. β: 0.03±0.03; P=0.44). We also observed marginal to strong effect modification by above versus at/below median postural change in BP for the association of cfPWV with urinary albumin‐creatinine ratio (Bonferroni-adjusted interaction P<0.001 to 0.01). Vascular measures were not related to left ventricular mass index or fractional anisotropy (Bonferroni-adjusted P values>0.05/20>0.0025).
Conclusions: Baroreflex dysfunction is associated with greater subclinical kidney damage. Additionally, relations of higher aortic stiffness with greater kidney damage may be modified by associated baroreflex dysregulation.