BACKGROUND: Orthostatic blood pressure (BP) dysregulation measured in-office predicts cardiovascular risk. However, the prevalence of self-measured home orthostatic hypo- and hypertension and their association with markers of atherosclerosis have not yet been described in a large sample of the general population.

METHODS: We performed cross-sectional analyses of home orthostatic BP reactions and pulse wave velocity (PWV), coronary artery calcium score (CACS), and carotid plaques in 4556 Swedish CArdioPulmonary bioImage Study (SCAPIS) participants who had performed home BP measurements and two home-standing BP measurements (Omron M10-IT device). Home orthostatic hypotension (home OH) was defined as a drop in BP after standing of systolic ≥20 mmHg or diastolic ≥10 mmHg, home orthostatic hypertension (home OHT) as an increase in systolic BP after standing of ≥20 mmHg.

RESULTS: Participants with home OH (n = 293, 6.4%) or OHT (n = 139, 3.1%) were more likely than participants with normal home orthostatic BP reactions to have ≥1 carotid plaque (65.5% and 64.7% vs. 55.3%, P < 0.001 and P = 0.027). Participants with home OH had higher PWV (9.2 ± 1.4 vs. 8.9 ± 1.3 m/s, P = 0.005) and were more likely to have CACS ≥ 100 (17.4 vs. 11.6%, P = 0.004). No such associations were observed for home OHT.

CONCLUSIONS: Self-measured home orthostatic hypo- and hypertension were associated with markers of atherosclerosis, and home orthostatic hypotension was also associated with arterial stiffness.