Greater Orthostatic Tolerance in Young Black Compared With White Women

We hypothesized that orthostatic tolerance is higher in young, healthy black compared with white women. To determine orthostatic tolerance, 22 women (11 black and 11 white) underwent graded lower body negative pressure to presyncope. We measured blood pressure, heart rate, and R-R interval (ECG) continuously at baseline and through all of the levels of lower body negative pressure. Blood samples were taken at baseline along with presyncope for the measurement of plasma catecholamine concentrations, serum aldosterone concentration, and plasma renin activity. Cumulative stress index, the sum of the product of time and lower body negative pressure, was the indicator of orthostatic tolerance. Orthostatic tolerance in the black women was greater than in the white women [cumulative stress index: -1003 (375) versus -476 (197); P<0.05]. Although plasma concentrations of norepinephrine increased in both groups at presyncope, the increase was greater in black [Delta plasma concentrations of norepinephrine: 167 (123)] versus white women [86 (64); P<0.05],as was the increase in PRA [Delta PRA 2.6 (1.0) versus 0.6 (0.9) ng of angiotensin II . mL(-1) . h(-1); P<0.05, for black and white women, respectively). Although heart rate increased and R-R interval decreased to a greater extent during lower body negative pressure in black women compared with white women (ANOVA: P<0.05), baroreflex function (ie, slope R-R interval versus systolic blood pressure) was unaffected by race. These data indicate that orthostatic tolerance is greater in black compared with white women, which appears to be a function of greater sympathetic nervous system responses to orthostatic challenges. (Hypertension. 2010; 56: 75-81.)