LAUSR

Objective: Orthostatic hypotension has been reported to be a risk factor for worsening heart failure (HF). The authors investigated prognostic values of blood pressure (BP) in the supine, sitting and standing positions, and those of postural variation of BP, in patients with HF. Design and method: Seventy-six consecutive cases (age, 81 ± 9y; male, 53%) who admitted to our hospital for HF and discharged after cardiac rehabilitation during a period from Jul 2014 to Jan 2016 were studied. Patients with atrial fibrillation, or who could not keep standing for 2 minutes at discharge, were not included. The left ventricular ejection fraction (LVEF) was preserved (40% or more) in 61 cases (80%). BPs were measured in the supine and sitting positions, and 1-min and 2-min after standing just before the discharges. The relationships among composite events (admission due to cardiovascular disease and all cause death) and demographic factors including BP and BP variation were investigated. Results: Over a median follow-up of 10.9 months, 26 composite events (readmission due to HF, 21; angina, 1; all-cause death, 4) occurred. Among subgroups of supine systolic BP (SBP) categories, the 1st quintile (77∼108mmHg) and the 4th+5th quintiles (126∼169mmHg) had increased risks of the composite events, compared with the 2nd+3rd quintiles (109∼125mmHg) (p < 0.01). On the other hand, there were no significant differences in the events rate among the subgroups of sitting or standing SBP categories. Among the subgroups of &dgr;SBP from the sitting position to 1-min standing, the 1st+2nd quintiles (−60∼-12mmHg) had more events than the 3rd+4th+5th quintiles (−11∼+30mmHg) did (p < 0.01). There was no significant association between &dgr;SBP from the supine to sitting position and prognosis. In a multivariate analysis, supine SBP, &dgr;SBP from the sitting positon to 1-min standing, and eGFR were significant prognostic factors. Conclusions: Both supine SBP and &dgr;SBP from the sitting to 1-min standing had independent prognostic values in patients with HF: they might reflect different mechanisms of worsening HF.