Orthostatic hyper-reactivity in young and middle-aged adults with stage I hypertension nearly doubles the risk of major cardiac and renal events, a multi-centre study shows.

Italian researchers say “exaggerated” systolic blood pressure (BP) responses to standing could flag the need for early pharmacotherapy and should be incorporated into future guidelines.

Based on data from 1200 participants under 45 years screened for stage I hypertension in the HARVEST (Hypertension and Ambulatory Recording Venetia) study, the authors investigated the predictive value of positional BP changes for cardiovascular outcomes.

A total of 105 major adverse cardiovascular events (MACE) — including acute coronary syndromes, fatal and non-fatal strokes and chronic kidney disease — were recorded during a median 17 years’ follow-up.