直立血压反应与心力衰竭事件的关联：弗雷明汉心脏研究。
Association of orthostatic blood pressure response with incident heart failure: The Framingham Heart Study.
机构信息
Department of Internal Medicine, Residency Program, Boston Medical Center, Boston, MA, United States of America.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States of America.
出版信息
PLoS One. 2022 Apr 22;17(4):e0267057. doi: 10.1371/journal.pone.0267057. eCollection 2022.
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.
重要性
直立性低血压（OH）和高血压（OHT）是与心血管疾病风险升高相关的异常血压调节状况。OH 和 OHT 与社区中心力衰竭（HF）风险的关系尚不清楚，并且关于它们与 HF 亚型[射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）]的关系的数据仍然很少。
目的
研究 OH 和 OHT 与 HF 风险及其亚型的关系。
设计
前瞻性观察队列。
设置
弗雷明汉心脏研究原始队列中的社区个体。
参与者
1914 名参与者（平均年龄 72 岁；1159 名女性）参加了第 17 次检查周期（1981-1984 年），随访至 2017 年 12 月 31 日，以记录 HF 或死亡的发生情况。
暴露因素
OH 或 OHT，定义为从仰卧位站立时收缩压/舒张压分别下降≥20/10mmHg。
结局和测量指标
在基线时，1241 名参与者的血压反应正常（749 名女性），274 名参与者有 OH（181 名女性），399 名参与者有 OHT（229 名女性）。我们使用 Cox 比例风险回归模型，将 OH 和 OHT 与 HF、HFrEF 和 HFpEF 的风险相关联，与不存在 OH 和 OHT（参考）相比，调整了年龄、性别、体重指数、收缩压和舒张压、高血压治疗、吸烟、糖尿病和总胆固醇/高密度脂蛋白。
结果
在随访期间（中位数为 13 年），我们观察到 492 例 HF 事件（女性 292 例；HFrEF 134 例，HFpEF 116 例，HF 不确定 EF 242 例）。与参照相比，OH 患者[84/274（31%）HF 事件]HF 风险更高（风险比[HR]1.47，95%置信区间[CI]1.13-1.91）。此外，OH 与 HFrEF 风险升高相关（HR 2.21，95%CI 1.34-3.67）。OHT 与 HF 风险无关。
结论和相关性
直立血压反应可能是 HF 风险的早期标志物。研究结果表明，血压调节和 HF（包括 HFrEF）的病理生理学存在共同机制。
Zotero 插件