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

Fedorowski, Artur; Hedblad, Bo; Engstr�m, Gunnar; Melander, Olle
May 2011
European Journal of Heart Failure;May2011, Vol. 13 Issue 5, p496
Academic Journal
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 Malm� 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 (?SBP and ?DBP), and mean arterial pressure (?MAP), using Cox proportional hazards models. Hazard ratio of incident HF increased across descending quartiles of ?SBP 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 ?MAP, 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 ?SBP 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.


Related Articles

  • Eplerenone and new-onset diabetes in patients with mild heart failure: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Preiss, David; van Veldhuisen, Dirk J.; Sattar, Naveed; Krum, Henry; Swedberg, Karl; Shi, Harry; Vincent, John; Pocock, Stuart J.; Pitt, Bertram; Zannad, Faiez; McMurray, John J.V. // European Journal of Heart Failure;Aug2012, Vol. 14 Issue 8, p909 

    Aims No studies have examined the effect of mineralocorticoid receptor antagonist therapy on new-onset diabetes. In addition, though the combination of diabetes and chronic heart failure (CHF) carries a poor prognosis, few studies have examined predictors of new-onset diabetes in those with CHF....

  • The COACH risk engine: a multistate model for predicting survival and hospitalization in patients with heart failure. Postmus, Douwe; van Veldhuisen, Dirk J.; Jaarsma, Tiny; Luttik, Marie Louise; Lassus, Johan; Mebazaa, Alexandre; Nieminen, Markku S.; Harjola, Veli-Pekka; Lewsey, James; Buskens, Erik; Hillege, Hans L. // European Journal of Heart Failure;Feb2012, Vol. 14 Issue 2, p168 

    Aims Several models for predicting the prognosis of heart failure (HF) patients have been developed, but all of them focus on a single outcome variable, such as all-cause mortality. The purpose of this study was to develop a multistate model for simultaneously predicting survival and HF-related...

  • Intracerebral haemorrhage profiles are changing: results from the Dijon population-based study. Béjot, Yannick; Cordonnier, Charlotte; Durier, Jérôme; Aboa-Eboulé, Corine; Rouaud, Olivier; Giroud, Maurice // Brain: A Journal of Neurology;Feb2013, Vol. 136 Issue 2, p658 

    Incidence of intracerebral haemorrhage over the past three decades is reported as stable. This disappointing finding is questionable and suggests that any reduction in intracerebral haemorrhage incidence associated with improvements in primary prevention, namely, better control of blood...

  • Influence of admission blood pressure on mortality in patients with acute decompensated heart failure. Pérez-Calvo, J. I.; Montero-Pérez-Barquero, M.; Camafort-Babkowski, M.; Conthe-Gutiérrez, P.; Formiga, F.; Aramburu-Bodas, O.; Romero-Requena, J. M. // QJM: An International Journal of Medicine;Apr2011, Vol. 104 Issue 4, p325 

    Objectives: To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF).Background: The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been...

  • Country of birth and risk of hospitalization due to heart failure: a Swedish population-based cohort study. Borné, Yan; Engström, Gunnar; Essén, Birgitta; Sundquist, Jan; Hedblad, Bo // European Journal of Epidemiology;Apr2011, Vol. 26 Issue 4, p275 

    To explore the relation between country of birth and risk of hospitalization due to heart failure (HF). All 40-89 year-old inhabitants in the city of Malmö, Sweden (n = 114,917, of whom 15.2% were born outside Sweden) were followed from November 1st, 1990 until December 31st, 2007. During a...

  • The Prevalence and Prognosis of Resistant Hypertension in Patients with Heart Failure. Jin, Chun-Na; Liu, Ming; Sun, Jing-Ping; Fang, Fang; Wen, Yong-Na; Yu, Cheuk-Man; Lee, Alex Pui-Wai // PLoS ONE;Dec2014, Vol. 9 Issue 12, p1 

    Background: Resistant hypertension is associated with adverse clinical outcome in hypertensive patients. However, the prognostic significance of resistant hypertension in patients with heart failure remains uncertain. Methods and Results: The 1 year survival and heart failure...

  • Burden of pelvis fracture: a population-based study of incidence, hospitalisation and mortality. Prieto-Alhambra, D.; Avilés, F.; Judge, A.; Staa, T.; Nogués, X.; Arden, N.; Díez-Pérez, A.; Cooper, C.; Javaid, M. // Osteoporosis International;Dec2012, Vol. 23 Issue 12, p2797 

    Summary: The objective of this study was to describe the incidence and consequences of pelvic fractures in a community cohort. The incidence of pelvic fractures increases with age with a protective effect of higher body mass index. Almost 60% of those with a pelvic fracture required an inpatient...

  • Left Atrial Function Predicts Heart Failure Events in Patients With Newly Diagnosed Left Ventricular Systolic Heart Failure During Short-Term Follow-Up. Chrysohoou, Christina; Kotroyiannis, Iason; Antoniou, Christos-Constadinos; Brili, Stella; Vaina, Sophia; Latsios, George; Tousoulis, Dimitris; Pitsavos, Christos; Stefanadis, Christodoulos // Angiology;Oct2014, Vol. 65 Issue 9, p817 

    We assessed the effect of left atrial (LA) function index, LA ejection fraction, LA kinetic energy, and maximal LA volume on 6 months clinical outcome in patients with newly diagnosed systolic heart failure (HF). During a 36-month period, 179 consecutive patients (17% female, mean age 63 ± 14...

  • Fish consumption and the risk of colorectal cancer: the Ohsaki Cohort Study. Sugawara, Y.; Kuriyama, S.; Kakizaki, M.; Nagai, M.; Ohmori-Matsuda, K.; Sone, T.; Hozawa, A.; Nishino, Y.; Tsuji, I. // British Journal of Cancer;9/1/2009, Vol. 101 Issue 5, p849 

    Background:Evidence from laboratory and animal studies suggests that high fish consumption may reduce the risk of colorectal cancer, but the results of studies in humans have been inconsistent. The objective of this study was to prospectively examine the association between fish consumption and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics