Relationship Between the Drop Rate of Standing Blood Pressure and Major Adverse Cardiovascular Events

IF 2.7 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of Clinical Hypertension Pub Date : 2025-05-10 DOI:10.1111/jch.70061

Wenqin Cai, Yuexian Yao, Suli Zheng, Wanting Chen, Lingxin Bao, Jinzi Su, Li Luo, Liangdi Xie

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Abstract

Orthostatic hypotension (OH) is defined as a decrease of ≥20 mm Hg systolic blood pressure (SBP) or ≥10 mm Hg diastolic blood pressure (DBP) within 3 min after standing. OH was associated with an increased risk of major adverse cardiovascular events (MACEs) and mortality. As an indicator reflecting the characteristics of orthostatic blood pressure (BP) changes, there is currently no research available on the relationship between the orthostatic BP drop rate and MACEs or mortality. A total of 448 hospitalized patients (mean age 62.07 ± 12.15 years, 35.49% female) completed the follow-up. The median follow-up duration was 5.09 years (0.29–6.13 years). Ninety-two patients (20.54%) developed OH, 12 patients died (2.68%), and 21 patients developed MACEs (4.69%), including 8 cases of non-fatal acute myocardial infarction (MI), 3 cases of non-fatal stroke, and 10 cases died of cardiovascular disease and stroke. Patients were categorized into the BP_{drop_rate_high} group (defined as SBP drop rate $\geq$ 15% and/or DBP drop rate $\geq$ 5% within 3 min after standing) and the BP_{drop_rate_normal} group (defined as SBP drop rate $<$ 15% and DBP drop rate $<$ 5% within 3 min after standing). The Chi-square test and Kaplan-Meier survival analysis indicated that the BP_{drop_rate_high} group had a higher risk of MACEs and mortality than the BP_{drop_rate_normal} group (all p $<$ 0.05). The Receiver Operating Characteristic (ROC) analysis demonstrated SBP drop rate $\geq$ 15% and/or DBP drop rate $\geq$ 5% within 3 min after standing has high diagnostic accuracy for OH, with an area under the curve (AUC) of 0.918.Cox regression analysis revealed that the cumulative survival rate of the BP_{drop_rate_normal} group was significantly higher than that of the BP_{drop_rate_high} group (98.45% vs. 93.69%, HR 0.304, 95% CI 0.095–0.969, p = 0.044). This study proposes a novel diagnostic threshold (SBP drop ≥15% and/or DBP drop ≥5% within 3 min after standing) for OH as a strong predictor of MACEs and mortality in hospitalized patients.

Trial Registration: MRCTA, ECFAH of FMU[2024]490

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站立血压下降率与主要心血管不良事件的关系

直立性低血压（OH）定义为站立后3分钟内收缩压（SBP）下降≥20 mm Hg或舒张压（DBP）下降≥10 mm Hg。OH与主要不良心血管事件（mace）和死亡率的风险增加有关。作为反映体位血压变化特征的指标，目前还没有关于体位血压下降率与mace或死亡率之间关系的研究。共有448例住院患者完成随访，平均年龄62.07±12.15岁，女性占35.49%。中位随访时间为5.09年（0.29-6.13年）。发生OH 92例（20.54%），死亡12例（2.68%），发生mace 21例（4.69%），其中非致死性急性心肌梗死（MI） 8例，非致死性脑卒中3例，心血管疾病及脑卒中死亡10例。患者被分为bpdrop_rate_高组（定义为站立后3分钟内收缩压下降率≥15%和/或舒张压下降率≥5%）和bpdrop_rate_正常组(定义为收缩压下降率<；$ \ & lt;$ 15%和DBP下降率<；$ & lt;站立后3分钟内支付5%)。卡方检验和Kaplan-Meier生存分析显示，BPdrop_rate_high组的mace和死亡风险高于BPdrop_rate_normal组(p <；$ & lt;$ 0.05)。受试者工作特征（ROC）分析显示，站立后3 min内收缩压下降率≥15%和/或DBP下降率≥5%对OH具有较高的诊断准确性，曲线下面积（AUC）为0.918。Cox回归分析显示，BPdrop_rate_normal组的累计生存率显著高于BPdrop_rate_high组（98.45% vs. 93.69%, HR 0.304, 95% CI 0.095 ~ 0.969, p = 0.044）。本研究提出了一个新的诊断阈值（站立后3分钟内收缩压下降≥15%和/或舒张压下降≥5%）作为住院患者mace和死亡率的有力预测指标。试验注册：MRCTA， ECFAH of FMU[2024]490

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来源期刊

Journal of Clinical Hypertension PERIPHERAL VASCULAR DISEASE-

CiteScore

5.80

自引率

7.10%

发文量

191

审稿时长

4-8 weeks

期刊介绍： The Journal of Clinical Hypertension is a peer-reviewed, monthly publication that serves internists, cardiologists, nephrologists, endocrinologists, hypertension specialists, primary care practitioners, pharmacists and all professionals interested in hypertension by providing objective, up-to-date information and practical recommendations on the full range of clinical aspects of hypertension. Commentaries and columns by experts in the field provide further insights into our original research articles as well as on major articles published elsewhere. Major guidelines for the management of hypertension are also an important feature of the Journal. Through its partnership with the World Hypertension League, JCH will include a new focus on hypertension and public health, including major policy issues, that features research and reviews related to disease characteristics and management at the population level.