Responses to Active Stand Test Predict 12-Year Incident Cardiovascular Disease and Mortality - Abstract - Plain Language Summary

Sep 29, 2026

An integrated haemodynamic response during standing may reflect neuro-cardiovascular function. The study tests whether combining the full heart rate (HR) and blood pressure (BP) response curves during an active stand (AS) identifies associations with incident cardiovascular disease (CVD) and all-cause mortality over 12 years. Beat-to-beat HR/BP data from 4336 adults were analyzed using functional principal components, then validated in an independent clinical cohort.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

communications medicine Article | A Nature Portfolio journal | | | | | --- | --- | --- | --- | | [https://doi.org/10.1038/s43856-025-01253-3](https://doi.org/10.1038/s43856-025-01253-3) | | | | | Responses to active stand test predict 12-year incident cardiovascular disease and mortality
Check for updates | | | | | Belinda Hernández 1,2,3 , Adam H. Dyer 2,4, Cathal McCrory1,2, Louise Newman1,2, Mark Ward 1,2, Ciaran Finucane2,5,6 & Rose Anne Kenny1,2,5 | | | | | Abstract Plain language summary | | | | | Background An integrated haemodynamic response during standing may serve asa 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.
Methods 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 duringAS, incident CVD and mortality over12years, 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.
Results 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 HRand 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) .
Conclusions 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 mortalityserving 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 singlemeasure 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 amore sensitive marker of cardiovascular health than existing measures. | | Adults typically stand from sitting or lying supine between 50-60 times per day1,2. The haemodynamic response to standing(or orthostasis)is a mild physiological stressor requiring integrated neuro-cardiovascular function, which can be readily assessed clinically through measurement of blood pressure (BP) and heart rate (HR) responses to formal active stand (AS) in the clinic3,4. In addition to its role in assessing for orthostatic hypotension | (OH) and autonomic dysfunction in older adults, the haemodynamic response to active stand can give an excellent indicator of the integrity of short-term cardiovascular and neurogenic responses5–7.
OH is deﬁned as a drop of ≥20 mmHg systolic/ ≥ 10 mmHg diastolic BP on standing from supine. In additio

FAQs

What does the active stand test measure in this study?

It measures heart rate (HR) and blood pressure (BP) responses during standing, using beat-to-beat recordings across the response curve rather than only single timepoints.

How were the HR/BP response curves analyzed?

The study applied functional principal components analysis to the entire HR/BP response curves and then assessed their longitudinal links with incident CVD and mortality.

Which response features were linked to mortality and cardiovascular outcomes?

Higher systolic BP before standing and blunted recovery of systolic BP during AS were associated with all-cause mortality. Impaired diastolic BP recovery after later seconds was linked to CVD in a validation cohort, while certain HR recovery patterns related to cardiovascular death risk.

Sep 29, 2026

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