Orthostatic Hypotension And Heart Failure

[firewatcher]

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

Fedorowski A, Hedblad B, Engström G, Melander O.

Eur J Heart Fail. 2011 Mar 15. [Epub ahead of print]

Department of Clinical Sciences, Lund University, Malmö, Sweden.

Abstract

AIMS: To study the prospective relationship of blood pressure response during orthostatic challenge with incidence of heart failure (HF).

METHODS AND RESULTS: In 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 (ΔSBP and ▵DBP), and mean arterial pressure (ΔMAP), using Cox proportional hazards models. Hazard ratio of incident HF increased across descending quartiles of ΔSBP from the first (and reference) quartile (+8.5 ± 4.9 mmHg), through the second (neutral response), to the third and fourth quartiles (-5.0 ± 0.1 and -13.7 ± 6.1 mmHg, respectively; P for linear trend=0.009). 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 ΔMAP, 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 (-5.2 ± 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 ΔSBP 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).

CONCLUSION: Early increase of blood pressure in response to orthostatic challenge signals reduced the risk of HF development.

PMID: 21406482

This doesn't quite fit with those of us dxed or suggested to have heart issues.

[juliegee]

I'm having a little trouble understanding this- kinda' technical for me foggy brain Seems to indicate that an initial increase in BP upon standing (that normalizes) is NOT correlated with heart failure, right? Or have I misunderstood?

Sort of makes sense. The heart is strong enough to compensate for the postural change by kickin' it up a notch momentarily resulting in a higher BP.

If one's heart didn't do that, the authors speculate it is indicative of future heart failure, right? It could indicate a weakness in the heart OR a misfunctioning ANS system...

You're right, Jennifer, this MAY not apply to us

[firewatcher]

Julie,

This finding is that people with a decrease in BP on standing are more likely to have HF in the future. Those whose BP did NOT drop or went up were less susceptible to HF in the future (according to this study.)

I have no idea what this would mean for us.

[potsgirl]

I have pretty severe orthostatic hypotension, so my BP drops dramatically when I stand up whereas my HR at least doubles (lying: BP 95/65, HR 60; standing: BP 72/62 and HR 125). I have also been diagnosed with bradycardia (have a pacer) and heart failure in the past, so the study makes sense to me. Some doctors don't believe that if you have a significant BP drop when standing that you have POTS, even if your HR increase by more than 30 beats, whereas others think they can go together. I have all of the symptoms of POTS, but I feel like I'm kind of in limbo....all of the treatments I've had have been your typical POTS ones. I just know that I have autonomic dysfunction, along with a variety of other associated problems like most of us on the site.

Interesting study. Thanks for posting it, firewatcher.

Cheers.