Background: Clinic brachial blood pressure (BP) is typically recorded in the seated, supine and standing positions. However, it is unknown whether central BP may be differentially altered with postural changes, and this may have treatment implications. This study aimed to assess brachial and central BP during different postures in patients with hypertension compared with controls.

Methods: Study population comprised 41 patients with hypertension receiving medication (HTN; aged 60±7 years; 22 male), 26 untreated patients with masked hypertension (MaskHTN; 57±9 years; 19 male) and 36 normotensive controls (aged 54±9 years; 22 male). The average of two brachial and central BP’s (by radial tonometry; SphygmoCor) were recorded in the seated, supine (after 3–5 minutes) and standing (after 2 minutes) positions.

Results: Supine brachial systolic BP (SBP) was significantly higher in patients with HTN (127±12 mmHg) and MaskHTN (130±10 mmHg) compared with controls (120±13 mmHg; p<0.05). As expected for the controls, seated brachial SBP was slightly, but non significantly (p>0.05), higher than both supine and standing positions. This non significant pattern was similar for central SBP in the controls and MaskHTN patients, but not patients with HTN, whose standing central SBP (109±12 mmHg) was significantly lower compared with the supine position (116±14 mmHg; p<0.05).

Conclusion: Posture has a differential effect on central, compared with brachial SBP in patients with treated hypertension. This highlights the importance of assessing central BP in these people, which may be particularly useful for managing patients with symptoms related to orthostatic hypotension.