title: Directionality of blood pressure response to standing may determine development of heart failure: prospective cohort study.
abstract: OBJECTIVE
  To study the prospective relationship of blood pressure response during orthostatic challenge with incidence of heart failure (HF).
  
  
  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).
  
  
  CONCLUSIONS
  Early increase of blood pressure in response to orthostatic challenge signals reduced the risk of HF development.
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden. artur.fedorowski@med.lu.se
authors.forename: Artur
authors.initials: A
authors.lastname: Fedorowski
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
mesh_terms: D000328:Adult; D017704:Baroreflex / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology*; D006439:Hemodynamics; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors