# Responses to active stand test predict 12-year incident cardiovascular disease and mortality

## TL;DR

This study shows that how blood pressure and heart rate respond when standing up can predict future heart disease and death risk better than standard measures.

## Contribution

The study introduces a novel approach by analyzing the full dynamic response of blood pressure and heart rate during standing to predict cardiovascular outcomes.

## Key findings

- Higher systolic blood pressure before standing and slower recovery are linked to increased mortality risk.
- Impaired blood pressure recovery after standing is associated with future cardiovascular disease.
- Heart rate patterns during standing correlate with reduced cardiovascular death risk.

## Abstract

An integrated haemodynamic response during standing may serve as a marker of neuro-cardiovascular function. Individual components of both heart rate (HR) and blood pressure (BP) responses to active stand (AS) have been linked with cardiovascular disease (CVD) and mortality. We hypothesised that integrating BP/HR information from the entire haemodynamic response curve may uncover otherwise unknown associations with both CVD and mortality.

Beat-to-beat measurements of dynamic HR/BP responses to AS were conducted in 4336 individuals (61.5 ± 8.2 years; 53.7% female). We assessed longitudinal associations between entire HR/BP response curves during AS, incident CVD and mortality over 12 years, and cross-sectional association with CVD on an independent clinical cohort. Functional Principal Components Analysis was applied to response curves, and their association with CVD and mortality was assessed.

In multivariable models, components with higher systolic BP (SBP) before AS and blunted recovery of SBP during AS are associated with all-cause mortality over 12-years (Hazard Ratio [HR]: 1.14; 1.04, 1.26; p = 0.007). Components with higher baseline/peak HR and lower HR from 30 seconds post stand are associated with lower Hazard of cardiovascular deaths (HR: 0.78; 0.64, 0.95; p = 0.013). Impaired recovery of DBP from 35 seconds onward is associated with CVD in a validation cohort (Odds Ratio: 0.65; 0.17, 0.88).

We observe distinct relationships between HR/BP responses to AS and 12-year incident CVD and mortality. BP recovery and CVD are also associated in an independent clinical validation cohort. Integrating the entire haemodynamic response may reveal more nuanced relationships between HR/BP responses to AS, CVD and mortality - serving as an integrative marker of neuro-cardiovascular health in midlife and beyond.

Standing up provides an effective test of the body’s nerve and heart regulation. This study investigated whether a person’s heart rate (HR) and blood pressure (BP) response to standing could better predict future risk of death and heart disease than standard single-measure summaries. Cardiovascular measures of ~4300 adults during a standing test were analysed to study the link between their response to standing, cardiovascular disease and mortality. Key findings revealed that high BP before standing and slow recovery of BP after standing were strongly linked to a higher risk of death. Additionally, poor BP and HR recovery were associated with future heart disease. These results suggest that using all available data in response to standing offers a more sensitive marker of cardiovascular health than existing measures.

Hernández et al. examine the link between heart rate and blood pressure response to active standing and future cardiovascular disease (CVD). Findings reveal distinct haemodynamic patterns linked to higher mortality and CVD risk, highlighting its potential as a marker for cardiovascular health.