Orthostatic Hypotension Linked to Heart Failure Development

A rapid drop in blood pressure when moving from lying down to standing up may signal a higher risk of developing heart failure, according to a long-term study funded by the National Heart, Blood and Lung Institute.

Those 45 to 55 years old showed a stronger link between orthostatic hypotension and heart failure than an older cohort, 56 to 64, according to researchers. High blood pressure was present in more than half of those in the study group who developed heart failure and could be partially responsible for the association, they added.

The association between orthostatic hypotension and developing heart failure was monitored over an average 17.5 years of follow-up. Orthostatic hypotension was defined as a decrease of 20 points or more in the systolic or a decrease of 10 or more points in the diastolic blood-pressure measurements.

Heart failure was identified in the study group by either hospital admission records or death certificates.

Of those who developed heart failure, about 11% had orthostatic hypotension at the start of the study, compared with only 4% of those who did not develop heart failure.

Patients with orthostatic hypotension had 1.54 times the risk of developing heart failure than those without orthostatic hypotension. When high blood pressure was excluded, that risk fell to 1.34 times.

“Orthostatic hypotension appears to be related to the development of heart failure along with other conditions known to cause heart failure,” said Christine DeLong Jones, MD, study lead author and preventive medicine resident at the University of North Carolina at Chapel Hill.

“Hypertension, diabetes and coronary heart disease are already known to contribute to a person’s risk of developing heart failure. Orthostatic blood pressure measurement may supplement what is already known about the risk for heart failure and requires no additional equipment, just a standard blood pressure cuff.”

While the study is the first of its kind to include both Caucasian and African-Americans, race did not appear to be much of a factor in development of heart failure related to orthostatic hypotension, Jones said.

Study participants were part of the Atherosclerosis Risk In Communities (ARIC) study, an ongoing longitudinal study of men and women in communities throughout the United States.

1. Jones CD, Loehr L, Franceschini N, Rosamond WD, Chang PP, Shahar E, Couper DJ, Rose KM. Orthostatic hypotension as a risk factor for incident heart failure: the atherosclerosis risk in communities study. Hypertension. 2012 May;59(5):913-8.Epub 2012 Mar 19. PubMed PMID: 22431580.

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