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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Bibliographic Details
Published in:PloS one Vol. 17; no. 4; p. e0267057
Main Authors: Shrout, Tara A., Pan, Stephanie, Mitchell, Gary F., Vasan, Ramachandran S., Xanthakis, Vanessa
Format: Journal Article
Language:English
Published: United States Public Library of Science 22.04.2022
Public Library of Science (PLoS)
Subjects:
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
United States
United States > US
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary: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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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0267057