Association of orthostatic blood pressure response with incident heart failure: The Framingham Heart Study
Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations wi...
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| Veröffentlicht in: | PloS one Jg. 17; H. 4; S. e0267057 |
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22.04.2022
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| Abstract | Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)].
Relate OH and OHT with HF risk and its subtypes.
Prospective observational cohort.
Community-based individuals in the Framingham Heart Study Original Cohort.
1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death.
OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position.
At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein.
On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk.
Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. |
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| AbstractList | Importance Relate OH and OHT with HF risk and its subtypes. Community-based individuals in the Framingham Heart Study Original Cohort. 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death. On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk. Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)]. Relate OH and OHT with HF risk and its subtypes. Prospective observational cohort. Community-based individuals in the Framingham Heart Study Original Cohort. 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death. OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position. At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein. On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk. Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. Importance Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)]. Objective Relate OH and OHT with HF risk and its subtypes. Design Prospective observational cohort. Setting Community-based individuals in the Framingham Heart Study Original Cohort. Participants 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981–1984) followed until December 31, 2017 for incident HF or death. Exposures OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position. Outcomes and measures At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein. Results On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13–1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34–3.67). OHT was not associated with HF risk. Conclusions and relevance Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. ImportanceOrthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)].ObjectiveRelate OH and OHT with HF risk and its subtypes.DesignProspective observational cohort.SettingCommunity-based individuals in the Framingham Heart Study Original Cohort.Participants1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death.ExposuresOH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position.Outcomes and measuresAt baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein.ResultsOn follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk.Conclusions and relevanceOrthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. Importance Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)]. Objective Relate OH and OHT with HF risk and its subtypes. Design Prospective observational cohort. Setting Community-based individuals in the Framingham Heart Study Original Cohort. Participants 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981–1984) followed until December 31, 2017 for incident HF or death. Exposures OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position. Outcomes and measures At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein. Results On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13–1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34–3.67). OHT was not associated with HF risk. Conclusions and relevance Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. Importance Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)]. Objective Relate OH and OHT with HF risk and its subtypes. Design Prospective observational cohort. Setting Community-based individuals in the Framingham Heart Study Original Cohort. Participants 1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death. Exposures OH or OHT, defined as a decrease or increase, respectively, of [greater than or equal to]20/10 mmHg in systolic/diastolic BP upon standing from supine position. Outcomes and measures At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein. Results On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk. Conclusions and relevance Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)].IMPORTANCEOrthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk. The relations of OH and OHT with heart failure (HF) risk in the community are unclear and there remains a paucity of data on the relations with HF subtypes [HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)].Relate OH and OHT with HF risk and its subtypes.OBJECTIVERelate OH and OHT with HF risk and its subtypes.Prospective observational cohort.DESIGNProspective observational cohort.Community-based individuals in the Framingham Heart Study Original Cohort.SETTINGCommunity-based individuals in the Framingham Heart Study Original Cohort.1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death.PARTICIPANTS1,914 participants (mean age 72 years; 1159 women) attending examination cycle 17 (1981-1984) followed until December 31, 2017 for incident HF or death.OH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position.EXPOSURESOH or OHT, defined as a decrease or increase, respectively, of ≥20/10 mmHg in systolic/diastolic BP upon standing from supine position.At baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein.OUTCOMES AND MEASURESAt baseline, 1,241 participants had a normal BP response (749 women), 274 had OH (181 women), and 399 had OHT (229 women). Using Cox proportional hazards regression models, we related OH and OHT to risk of HF, HFrEF, and HFpEF compared to the absence of OH and OHT (reference), adjusting for age, sex, body mass index, systolic and diastolic BP, hypertension treatment, smoking, diabetes, and total cholesterol/high-density lipoprotein.On follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk.RESULTSOn follow-up (median 13 years) we observed 492 HF events (292 in women; 134 HFrEF, 116 HFpEF, 242 HF indeterminate EF). Compared to the referent, participants with OH [n = 84/274 (31%) HF events] had a higher HF risk (Hazards Ratio [HR] 1.47, 95% CI 1.13-1.91). Moreover, OH was associated with a higher HFrEF risk (HR 2.21, 95% CI 1.34-3.67). OHT was not associated with HF risk.Orthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF.CONCLUSIONS AND RELEVANCEOrthostatic BP response may serve as an early marker of HF risk. Findings suggest shared pathophysiology of BP regulation and HF, including HFrEF. |
| Audience | Academic |
| Author | Vasan, Ramachandran S. Shrout, Tara A. Xanthakis, Vanessa Pan, Stephanie Mitchell, Gary F. |
| AuthorAffiliation | 6 Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America 8 Framingham Heart Study, Framingham, MA, United States of America 1 Department of Internal Medicine, Residency Program, Boston Medical Center, Boston, MA, United States of America 4 Cardiovascular Engineering, Norwood, MA, United States of America 5 Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, United States of America Universita degli Studi di Napoli Federico II, ITALY 3 Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America 2 Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States of America 7 Boston University Center for Computing and Data Sciences, Boston, MA, United States of America |
| AuthorAffiliation_xml | – name: 1 Department of Internal Medicine, Residency Program, Boston Medical Center, Boston, MA, United States of America – name: 8 Framingham Heart Study, Framingham, MA, United States of America – name: 3 Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America – name: Universita degli Studi di Napoli Federico II, ITALY – name: 5 Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, United States of America – name: 4 Cardiovascular Engineering, Norwood, MA, United States of America – name: 2 Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States of America – name: 6 Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America – name: 7 Boston University Center for Computing and Data Sciences, Boston, MA, United States of America |
| Author_xml | – sequence: 1 givenname: Tara A. surname: Shrout fullname: Shrout, Tara A. – sequence: 2 givenname: Stephanie orcidid: 0000-0002-5012-2335 surname: Pan fullname: Pan, Stephanie – sequence: 3 givenname: Gary F. surname: Mitchell fullname: Mitchell, Gary F. – sequence: 4 givenname: Ramachandran S. surname: Vasan fullname: Vasan, Ramachandran S. – sequence: 5 givenname: Vanessa orcidid: 0000-0002-7352-621X surname: Xanthakis fullname: Xanthakis, Vanessa |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35452474$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1161_HYPERTENSIONAHA_123_21210 |
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| DOI | 10.1371/journal.pone.0267057 |
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| DocumentTitleAlternate | Orthostatic blood pressure response and heart failure: The Framingham Heart Study |
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| Snippet | Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular disease risk.... Importance Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular... Importance Relate OH and OHT with HF risk and its subtypes. Community-based individuals in the Framingham Heart Study Original Cohort. 1,914 participants (mean... ImportanceOrthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular... Importance Orthostatic hypotension (OH) and hypertension (OHT) are aberrant blood pressure (BP) regulation conditions associated with higher cardiovascular... |
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| SubjectTerms | Age Aged Antihypertensives Blood Pressure Body mass Body mass index Body size Cardiovascular disease Cardiovascular diseases Cholesterol Congestive heart failure Diabetes Diabetes mellitus Ejection fraction Epidemiology Female Glucose Hazards Health aspects Health care Health hazards Health risks Heart Failure High density lipoprotein Humans Hypertension Hypertension - complications Hypertension - epidemiology Hypotension Hypotension, Orthostatic - complications Hypotension, Orthostatic - epidemiology Longitudinal Studies Male Measurement Medicine and Health Sciences Orthostatic hypotension Position measurement Preventive medicine Prognosis Public health Regression analysis Regression models Risk Risk Factors Smoking Stroke Volume Supine position |
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| Title | Association of orthostatic blood pressure response with incident heart failure: The Framingham Heart Study |
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