Directionality of blood pressure response to standing may determine development of heart failure: prospective cohort study

Abstract

AimsTo study the prospective relationship of blood pressure response during orthostatic challenge with incidence of heart failure (HF). Methods and resultsIn a Swedish prospective cohort study (the Malmö Preventive Project), we followed up 32 669 individuals (68.2% men; mean age, 46 years) over a period of 24 years. Incidence of first hospitalization due to new-onset HF was related to early (60 -120 s) postural changes in systolic and diastolic blood pressure (DSBP and △DBP), and mean arterial pressure (DMAP), using Cox proportional hazards models. Hazard ratio of incident HF increased across descending quartiles of DSBP from the first (and reference) quartile (+8.5 + 4.9 mmHg), through the second (neutral response), to the third and fourth quartiles (25.0 + 0.1 and 213.7 + 6.1 mmHg, respectively; P for linear trend¼0.009). A pronounced hypotensive SBP response (fourth quartile) conferred the highest risk of new-onset HF [hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.11-1.53]. A similar pattern was observed with regard to DMAP, where the first (and reference) quartile with a marked positive MAP response (+7.7 + 3.1 mmHg) had the lowest, and the fourth quartile with a hypotensive MAP response (25.2 + 3.4 mmHg) had the highest HF risk (HR for fourth vs. first quartile: 1.37; 95% CI, 1.17-1.62). In a continuous model, the risk of incident HF conferred by negative DSBP matched that of resting SBP (HR per 10 mmHg difference: 1.17; 95% CI, 1.11-1.23, and 1.17, 1.14-1.20, respectively), whereas MAP drop was the strongest individual predictor of HF development (HR 1.26, 95% CI, 1.21-1.31). ConclusionEarly increase of blood pressure in response to orthostatic challenge signals reduced the risk of HF development.--

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

“…Similarly, Hartog et al reported a possible association between OHT and lower all‐cause mortality in a study with nursing home residents (Table ). Finally, the Malmö Preventive Project investigators demonstrated an inverse relationship between systolic BP increase after standing and incidence of heart failure, however, no separate analysis was performed for subjects with OHT, that is, for subjects with orthostatic systolic BP increased above a threshold of 10 or 20 mm Hg …”

Orthostatic blood pressure response, carotid intima–media thickness, and plasma fibrinogen in older nondiabetic adults

“…Among baseline biomarkers, only NT-proBNP independently predicted orthostatic hypertension, although MR-proADM, MRproANP, and cystatin C were also increased. This finding is very intriguing in the light of previous studies indicating that hypertensive orthostatic response is inversely related with incident heart failure [31], and that NT-proBNP predicts cardiovascular events [21]. A possible explanation of this …”

Non-pharmacological management of orthostatic hypotension in the older patient

“…[7][8][9][10][11][12][13] The European Guidelines on the management of OH recommend a nonpharmacological approach as first-line therapy. 21 The mainstay of non-pharmacological therapy consists of advice regarding the avoidance of precipitants, physical counter-manoeuvres, 1.5-2 litres of daily water consumption, moderate salt supplementation and leg binders.…”

“…Symptomatic or asymptomatic OH detected in middle or late life increases the likelihood of incident co-morbid diseases of various types on follow-up. In middle-aged people for example, OH correlates with later life incident heart failure (hazard ratio (HR) 1.31, 95% CI: 1.05-1.63), 9 later life incident kidney disease (HR 2.0, 95% CI: 1.5-2.8), 10 incident coronary events (HR 1.6, 95% CI: 1.3-1.9), 11 and atrial fibrillation (HR 1.30, 95% CI: 1.05-1.61). 12 In the older population, OH is associated with all cause mortality (HR 1.22, 95% CI: 1.1-1.36).…”