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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1883931
- author
- Fedorowski, Artur
LU
; Hedblad, Bo
LU
; Engström, Gunnar
LU
and Melander, Olle
LU
- organization
- publishing date
- 2011
- 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
- 2016-04-01 10:49:35
- date last changed
- 2024-01-07 02:10:10
@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 = {{https://lup.lub.lu.se/search/files/2164567/1894711.pdf}},
doi = {{10.1093/eurjhf/hfr013}},
volume = {{13}},
year = {{2011}},
}