{"id":"45971","type":"article","url":"https://hartvaat.nl/2026/05/20/aric-over-35-jaar-hogere-bloeddruk-niet-alleen-lage-staande-bd-verklaart-syncope/","title":"ARIC over 35 jaar: hogere bloeddruk — niet alleen lage staande BD — verklaart syncope, vallen én CHD","title_en":"Orthostatic Blood Pressure, Cardiovascular Disease, and Hypotensive Events","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25773","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25773","authors":[],"significance":7,"published":"2026-07-06","source_date":"2026-05-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"Analysis of the Atherosclerosis Risk in Communities (ARIC) study: in 11,386 participants (mean age 54 years; 56% female; 25% Black), supine and standing BP were measured once at baseline, with over 35 years of follow-up for coronary heart disease, mortality, falls, and syncope. Drops in systolic BP on standing (absolute or relative) were associated with coronary heart disease, syncope, and mortality. In untreated participants, higher supine systolic BP and mean arterial pressure were associated with syncope. An increase in systolic BP ≥20 mm Hg on standing was associated with more falls (HR 1.52) and syncope (HR 1.40). In treated participants, lower standing BP did predict more syncope (HR 1.55). Regardless of treatment, higher pulse pressure was associated with CHD and mortality, but not with falls or syncope. The findings nuance the view that only low standing BP is the problem: higher BP appears an important risk factor for both cardiovascular and hypotension-related events, particularly in untreated adults.","created":"2026-07-03T20:27:00Z","updated":"2026-07-04T19:27:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de Atherosclerosis Risk in Communities (ARIC)-studie: bij 11.386 deelnemers (gemiddelde leeftijd 54 jaar; 56% vrouw; 25% zwart) werden liggende en staande bloeddruk eenmalig op baseline gemeten, met meer dan 35 jaar follow-up voor coronaire hartziekte, sterfte, vallen en syncope. Daling van systolische BD bij staan (absoluut of relatief) was geassocieerd met coronaire hartziekte, syncope en mortaliteit. Bij niet-behandelde deelnemers waren hogere liggende systolische BD en gemiddelde arteriële druk geassocieerd met syncope. Een stijging van systolische BD ≥20 mmHg bij staan was geassocieerd met meer vallen (HR 1,52) en syncope (HR 1,40). Bij behandelde personen voorspelde lagere staande BD wél meer syncope (HR 1,55). Ongeacht behandeling was hogere polsdruk geassocieerd met CHD en mortaliteit, maar niet met vallen of syncope. De bevindingen nuanceren het beeld dat alleen lage staande BD het probleem zou zijn: hogere bloeddruk blijkt een belangrijke risicofactor voor zowel cardiovasculaire als hypotensie-gerelateerde events, vooral bij niet-behandelde personen.","abstract_original":"BACKGROUND:Orthostatic hypotension is thought to be associated with coronary heart disease, falls, and syncope due to low blood pressure (BP) upon standing.METHODS:The ARIC study (Atherosclerosis Risk in Communities) measured supine and standing BP among adult participants aged 45 to 64 years once at baseline and followed them for over 35 years. We evaluated higher and lower supine and standing systolic BP, diastolic BP, mean arterial pressure, pulse pressure, absolute and relative orthostatic changes in BP after standing, and mean BP across positions. Associations with adjudicated coronary heart disease and mortality events, as well as hospitalizations and medical claims-based falls and syncope, were assessed via adjusted Cox models in strata of antihypertensive treatment.RESULTS:Among 11 386 participants (mean age, 54 years [SD, 5.7 years]; 56% female; 25% Black adults), drops in systolic BP upon standing (absolute or relative) were associated with coronary heart disease, syncope, and mortality. Higher supine systolic BP and mean arterial pressure were associated with syncope among untreated participants. Increases in systolic BP ≥20 mm Hg upon standing were associated with falls (hazard ratio, 1.52 [95% CI, 1.14–2.02]) and syncope (hazard ratio, 1.40 [95% CI, 1.03–1.92]), particularly among untreated participants. Lower standing systolic BP was associated with a higher risk of syncope among treated participants (hazard ratio, 1.55 [95% CI, 1.14–2.12]). Regardless of treatment status, a higher pulse pressure was associated with coronary heart disease and mortality, but this was not observed for falls or syncope.CONCLUSIONS:Higher BP, rather than lower standing BP alone, may be an important risk factor for both cardiovascular and hypotension-related events, especially among untreated adults."}