{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T12:38:26Z","timestamp":1793709506469,"version":"4.6.1"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"Importance<\/jats:title>Nocturnal hypertension while asleep is associated with substantial increases in risk of cardiovascular disease (CVD) and death. Whether hypertension while supine is a risk factor associated with CVD independent of seated hypertension remains unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association between supine hypertension and CVD outcomes and by hypertension treatment status.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective cohort study used data from the Atherosclerosis Risk in Communities (ARIC) study, which was established in 1987 to examine cardiovascular risk factors among middle-aged adults from 4 communities in the US. Supine and seated blood pressure were measured in more than 13\u202f000 middle-aged adults with longitudinal surveillance for CVD over 27 years. Participants with a history of coronary heart disease (CHD), heart failure, or stroke were excluded. Data were analyzed from May 2023 through December 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Supine hypertension (supine systolic blood pressure \u2265130 or diastolic blood pressure \u226580 mm Hg) with and without seated hypertension (seated systolic blood pressure \u2265130 or diastolic blood pressure \u226580 mm Hg).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Cox proportional hazard models with adjustment for CVD risk factors were performed to investigate the association of supine hypertension with and without seated hypertension with incident CHD, heart failure, stroke, fatal CHD, and all-cause mortality.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 11\u202f369 participants without known CVD (6332 female [55.7%] and 5037 male [44.3%]; 2858 Black [25.1%] and 8511 White [74.9%]; mean [SD] age 53.9 [5.7] years]), 16.4% (95% CI, 15.5%-17.2%) of those without seated hypertension had supine hypertension and 73.5% (95% CI, 72.2%-74.8%) of those with seated hypertension had supine hypertension. Supine hypertension was associated with incident CHD (hazard ratio [HR], 1.60; 95% CI, 1.45-1.76), heart failure (HR, 1.83; 95% CI, 1.68-2.01), stroke (HR, 1.86; 95% CI, 1.63-2.13), fatal CHD (HR, 2.18; 95% CI, 1.84-2.59), and all-cause mortality (HR, 1.43; 95% CI, 1.35-1.52) during a median (25th, 75th percentile) follow-up of 25.7 (15.4, 30.4) years, 26.9 (17.6, 30.5) years, 27.6 (18.5, 30.6 years), 28.3 (20.5, 30.7) years, and 28.3 (20.5 years, 30.7) years, respectively. There were no meaningful differences by seated hypertension status. Results were similar by hypertension medication use. Participants with supine hypertension alone had risk associations similar to those of participants with hypertension in both positions and significantly greater than those of participants with seated hypertension alone with the exception of fatal CHD; seated vs supine HRs were 0.72 (95% CI, 0.61-0.85) for CHD, 0.72 (95% CI, 0.60-0.85) for heart failure, 0.66 (95% CI, 0.51-0.86) for stroke, and 0.83 (95% CI, 0.74-0.92) for all-cause mortality.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Supine hypertension regardless of seated hypertension had a higher HR for CVD risk than seated hypertension alone. Future research should evaluate supine hypertension in the setting of nocturnal hypertension and as an independent target of blood pressure treatment.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2024.5213","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T16:33:45Z","timestamp":1737563625000},"page":"265","source":"Crossref","is-referenced-by-count":22,"title":["Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality"],"prefix":"10.1001","volume":"10","author":[{"given":"Duc M.","family":"Giao","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Col","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick","family":"Larbi Kwapong","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth-Alma","family":"Turkson-Ocran","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long H.","family":"Ngo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Cluett","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne","family":"Wagenknecht","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Gwen","family":"Windham","sequence":"additional","affiliation":[{"name":"Memory Impairment and Neurodegenerative Dementia Center, Department of Medicine, University of Mississippi Medical Center, Jackson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Selvin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela L.","family":"Lutsey","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Juraschek","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"9349","key":"hoi240085r1","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1016\/S0140-6736(02)11911-8","article-title":"Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.","volume":"360","author":"Lewington","year":"2002","journal-title":"Lancet"},{"issue":"10285","key":"hoi240085r2","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1016\/S0140-6736(21)00590-0","article-title":"Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis.","volume":"397","author":"Blood Pressure Lowering Treatment Trialists\u2019 Collaboration","year":"2021","journal-title":"Lancet"},{"issue":"19","key":"hoi240085r3","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1161\/CIRCULATIONAHA.120.049730","article-title":"Nighttime blood pressure phenotype and cardiovascular prognosis: practitioner-based nationwide JAMP study.","volume":"142","author":"Kario","year":"2020","journal-title":"Circulation"},{"issue":"5","key":"hoi240085r4","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1001\/jama.2019.9811","article-title":"Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes.","volume":"322","author":"Yang","year":"2019","journal-title":"JAMA"},{"issue":"5","key":"hoi240085r5","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1093\/ajh\/hpaa184","article-title":"The association of orthostatic hypotension with ambulatory blood pressure phenotypes in SPRINT.","volume":"34","author":"Ghazi","year":"2021","journal-title":"Am J Hypertens"},{"issue":"2","key":"hoi240085r6","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1097\/HJH.0000000000003604","article-title":"Orthostatic hypotension, orthostatic hypertension, and ambulatory blood pressure in patients with chronic kidney disease in CRIC.","volume":"42","author":"Ghazi","year":"2024","journal-title":"J Hypertens"},{"issue":"2","key":"hoi240085r7","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1093\/ajh\/hpw108","article-title":"Orthostatic hypotension in middle-age and risk of falls.","volume":"30","author":"Juraschek","year":"2017","journal-title":"Am J Hypertens"},{"issue":"9","key":"hoi240085r8","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1001\/jamainternmed.2017.2937","article-title":"Association of history of dizziness and long-term adverse outcomes with early vs later orthostatic hypotension assessment times in middle-aged adults.","volume":"177","author":"Juraschek","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"10","key":"hoi240085r9","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008884","article-title":"Orthostatic hypotension and risk of clinical and subclinical cardiovascular disease in middle-aged adults.","volume":"7","author":"Juraschek","year":"2018","journal-title":"J Am Heart Assoc"},{"issue":"11","key":"hoi240085r10","doi-asserted-by":"publisher","first-page":"2437","DOI":"10.1161\/HYPERTENSIONAHA.123.21215","article-title":"Association of supine hypertension versus standing hypotension with adverse events among middle-aged adults.","volume":"80","author":"Earle","year":"2023","journal-title":"Hypertension"},{"issue":"23","key":"hoi240085r11","doi-asserted-by":"publisher","first-page":"2939","DOI":"10.1016\/j.jacc.2021.04.035","article-title":"The ARIC (Atherosclerosis Risk In Communities) study: JACC focus seminar 3\/8.","volume":"77","author":"Wright","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"12","key":"hoi240085r12","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1016\/0895-4356(95)00047-X","article-title":"Differences between respondents and nonrespondents in a multicenter community-based study vary by gender ethnicity.","volume":"49","author":"Jackson","year":"1996","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"hoi240085r13","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/0895-4356(95)00041-0","article-title":"Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) study: methods and initial two years\u2019 experience.","volume":"49","author":"White","year":"1996","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"hoi240085r15","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1161\/HYP.0000000000000066","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNa guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"issue":"1","key":"hoi240085r16","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.cardfail.2015.07.013","article-title":"Identification of heart failure events in Medicare claims: the Atherosclerosis Risk in Communities (ARIC) study.","volume":"22","author":"Kucharska-Newton","year":"2016","journal-title":"J Card Fail"},{"issue":"4","key":"hoi240085r17","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1093\/oxfordjournals.aje.a115184","article-title":"The Atherosclerosis Risk in Communities (ARIC) study: design and objectives: the ARIC investigators.","volume":"129","author":"Atherosclerosis Risk in Communities Investigators","year":"1989","journal-title":"Am J Epidemiol"},{"issue":"4","key":"hoi240085r18","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1093\/ije\/24.4.685","article-title":"Ability of the Atherosclerosis Risk in Communities (ARIC)\/Baecke Questionnaire to assess leisure-time physical activity.","volume":"24","author":"Richardson","year":"1995","journal-title":"Int J Epidemiol"},{"issue":"19","key":"hoi240085r19","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race.","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"issue":"368","key":"hoi240085r20","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1080\/01621459.1979.10481038","article-title":"Robust locally weighted regression and smoothing scatterplots.","volume":"74","author":"Cleveland","year":"1979","journal-title":"J Am Stat Assoc"},{"issue":"6","key":"hoi240085r21","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1161\/CIRCULATIONAHA.123.067626","article-title":"Development and validation of the American Heart Association\u2019s PREVENT equations.","volume":"149","author":"Khan","year":"2024","journal-title":"Circulation"},{"issue":"15","key":"hoi240085r22","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1093\/jnci\/80.15.1198","article-title":"Regression models in clinical studies: determining relationships between predictors and response.","volume":"80","author":"Harrell","year":"1988","journal-title":"J Natl Cancer Inst"},{"issue":"446","key":"hoi240085r23","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk.","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"issue":"6","key":"hoi240085r24","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1161\/HYPERTENSIONAHA.118.10971","article-title":"Nocturnal hypertension: new technology and evidence.","volume":"71","author":"Kario","year":"2018","journal-title":"Hypertension"},{"issue":"1","key":"hoi240085r25","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/j.1365-2702.2005.01494.x","article-title":"The effect of different body positions on blood pressure.","volume":"16","author":"Eser","year":"2007","journal-title":"J Clin Nurs"},{"issue":"7","key":"hoi240085r26","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1038\/sj.jhh.1001573","article-title":"Both body and arm position significantly influence blood pressure measurement.","volume":"17","author":"Netea","year":"2003","journal-title":"J Hum Hypertens"},{"issue":"10","key":"hoi240085r27","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1038\/ajh.2011.106","article-title":"Differences in blood pressure by body position (supine, Fowler\u2019s, and sitting) in hypertensive subjects.","volume":"24","author":"Cicolini","year":"2011","journal-title":"Am J Hypertens"},{"issue":"6","key":"hoi240085r28","doi-asserted-by":"publisher","first-page":"707","DOI":"10.2143\/AC.63.6.2033387","article-title":"Differences in blood pressure readings between supine and sitting positions in hypertensive patients.","volume":"63","author":"Lu","year":"2008","journal-title":"Acta Cardiol"},{"issue":"966","key":"hoi240085r29","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1136\/pgmj.2005.037457","article-title":"The patient with supine hypertension and orthostatic hypotension: a clinical dilemma.","volume":"82","author":"Naschitz","year":"2006","journal-title":"Postgrad Med J"},{"issue":"4","key":"hoi240085r30","doi-asserted-by":"publisher","first-page":"219","DOI":"10.12788\/jhm.3580","article-title":"Supine-related pseudoanemia in hospitalized patients.","volume":"16","author":"Derakhshan","year":"2021","journal-title":"J Hosp Med"},{"issue":"5","key":"hoi240085r31","doi-asserted-by":"publisher","first-page":"611","DOI":"10.4065\/80.5.611","article-title":"Postural pseudoanemia: posture-dependent change in hematocrit.","volume":"80","author":"Jacob","year":"2005","journal-title":"Mayo Clin Proc"},{"issue":"4","key":"hoi240085r32","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1136\/jcp.13.4.304","article-title":"Effects of posture on plasma volume and some blood constituents.","volume":"13","author":"Fawcett","year":"1960","journal-title":"J Clin Pathol"},{"issue":"4","key":"hoi240085r33","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1093\/ajcp\/49.4.491","article-title":"Effect of posture on hematology results.","volume":"49","author":"Tombridge","year":"1968","journal-title":"Am J Clin Pathol"},{"issue":"3","key":"hoi240085r34","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1152\/jappl.1978.45.3.414","article-title":"Plasma volume changes with movement to supine and standing positions.","volume":"45","author":"Hagan","year":"1978","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"issue":"2","key":"hoi240085r35","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1111\/j.1748-1716.1995.tb09960.x","article-title":"Redistribution of body fluids during postural manipulations.","volume":"155","author":"Maw","year":"1995","journal-title":"Acta Physiol Scand"},{"issue":"1","key":"hoi240085r36","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1177\/0300060516677175","article-title":"Association of blood pressure in the supine position with target organ damage in subjects over 60 years old.","volume":"45","author":"Wang","year":"2017","journal-title":"J Int Med Res"},{"key":"hoi240085r37","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2023055","article-title":"Association of blood pressure measurements in sitting, supine, and standing positions with the 10-year risk of mortality in Korean adults.","volume":"45","author":"Baik","year":"2023","journal-title":"Epidemiol Health"},{"key":"hoi240085r14","unstructured":"The Atherosclerosis Risk in Communities Study (ARIC). Sitting blood pressure and postural changes in blood pressure and heart rate. University of North Carolina at Chapel Hill. Accessed April 4, 2016. https:\/\/aric.cscc.unc.edu\/aric9\/node\/34707"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2828914\/jamacardiology_giao_2025_oi_240085_1741367257.34918.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T15:02:02Z","timestamp":1741791722000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2828914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2024.5213","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}