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

Fedorowski, Artur LU ; Hedblad, Bo LU ; Engström, Gunnar LU and Melander, Olle LU (2011) In European Journal of Heart Failure 13. p.496-503
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Heart Failure
volume
13
pages
496 - 503
publisher
Elsevier
external identifiers
  • wos:000289795000006
  • pmid:21406482
  • scopus:79955454219
ISSN
1879-0844
DOI
10.1093/eurjhf/hfr013
language
English
LU publication?
yes
id
865cdf7d-c232-401a-84e0-94ffded15721 (old id 1883931)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21406482?dopt=Abstract
date added to LUP
2011-04-01 16:05:19
date last changed
2017-01-01 03:55:51
@article{865cdf7d-c232-401a-84e0-94ffded15721,
  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.},
  author       = {Fedorowski, Artur and Hedblad, Bo and Engström, Gunnar and Melander, Olle},
  issn         = {1879-0844},
  language     = {eng},
  pages        = {496--503},
  publisher    = {Elsevier},
  series       = {European Journal of Heart Failure},
  title        = {Directionality of blood pressure response to standing may determine development of heart failure: prospective cohort study.},
  url          = {http://dx.doi.org/10.1093/eurjhf/hfr013},
  volume       = {13},
  year         = {2011},
}