Blood Pressure Response and Symptoms During Active Standing Test Among Hospitalized and Outpatients With Heart Failure: Results From the GRAVITY-HF Prospective Observational Cohort Study

Background: We conducted a multicenter, prospective, observational study to describe the incidence of orthostatic hypotension (OH) and orthostatic hypertension (OHtn) and its association with symptoms at standing and outcomes in patients with heart failure (HF). Methods and Results: 321 active standing tests were performed in 87 inpatients during admission, and 316 tests were performed in 208 outpatients during follow-up. Blood pressure (BP) was measured by an automatic device 4 times in the supine position and at 1, 3 and 5 minutes of standing. Patients were queried about symptoms of orthostatic intolerance. The incidence of OH and OHtn was similar in both groups at baseline (classical OH 11%–22%, OHtn 3%–8%, depending on definition and timing). Reproducibility of BP changes with standing was low. Up to 50% of cases with abnormal responses were asymptomatic. Symptoms were variable and occurred mainly during the first minute of standing and had a U-shaped association with BP changes. OH in outpatients with HF was associated with a higher risks of death or readmission due to HF. Conclusions: Patients with HF have variable hemodynamic responses and symptoms during repeated active standing tests. OH might identify outpatients with HF who are at risk of long-term negative outcomes. © 2024 Elsevier Inc.

Authors
Soloveva A. , Fedorova D. , Fudim M. , Vinogradova N. , Chemodanova A. , Kozlova A. , Fomin I. , Skuratova M. , Shneidmiller N. , Golovina G. , Kosmacheva E. , Gubareva E. , Teterina M. , Godunko E. , Chesnikova A. , Okunev I. , Kashtalap V. , Kuznetsova M. , Dzhioeva O. , Kopeva K. , Zvartau N. , Villevalde S.
Publisher
Churchill Livingstone Inc.
Number of issue
7
Language
English
Pages
890-903
Status
Published
Volume
30
Year
2024
Organizations
  • 1 Almazov National Medical Research Centre, Department of Cardiology, Saint Petersburg, Russian Federation
  • 2 Duke University Medical Center, Division of Cardiology, Durham, NC, United States
  • 3 Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russian Federation
  • 4 City Clinical Hospital No. 38, Nizhny Novgorod, Russian Federation
  • 5 Samara City Clinical Hospital № 1 named after Pirogov N.I., Samara, Russian Federation
  • 6 State Budget Health Care Institution Scientific Research Institute-Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russian Federation
  • 7 Kuban State Medical University, Krasnodar, Russian Federation
  • 8 Samara State Medical University, Samara, Russian Federation
  • 9 Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation
  • 10 Rostov State Medical University, Rostov-on-Don, Russian Federation
  • 11 Rostov Regional Clinical Hospital, Rostov-on-Don, Russian Federation
  • 12 Federal State Budgetary Educational Institution of Higher Education Kemerovo State Medical University, Kemerovo, Russian Federation
  • 13 State Budgetary Healthcare Institution of the Kemerovo Region Kemerovo Regional Clinical Cardiology Dispensary named after academician L.S. Barbarash, Kemerovo, Russian Federation
  • 14 Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
  • 15 Pirogov Russian National Research Medical University, Moscow, Russian Federation
  • 16 National Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
  • 17 Cardiology Research Institute, Tomsk National Research Medical Center of Russian Academy of Science, Tomsk, Russian Federation
Keywords
Aged; Aged, 80 and over; Blood Pressure; Blood Pressure Determination; Cohort Studies; Female; Follow-Up Studies; Heart Failure; Hospitalization; Humans; Hypotension, Orthostatic; Inpatients; Male; Middle Aged; Outpatients; Prospective Studies; Standing Position; amino terminal pro brain natriuretic peptide; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; digoxin; dipeptidyl carboxypeptidase inhibitor; diuretic agent; enkephalinase inhibitor; furosemide; hemoglobin; ivabradine; loop diuretic agent; mineralocorticoid antagonist; aged; Article; asymptomatic disease; cause of death; clinical assessment; clinical trial; cohort analysis; diagnostic test; diastolic blood pressure; disease association; female; follow up; heart failure; hemodynamic parameters; hospital admission; hospital patient; hospital readmission; hospitalization; human; incidence; long term care; major clinical study; male; multicenter study; observational study; orthostatic hypertension; orthostatic hypotension; orthostatic intolerance; outcome assessment; outpatient care; prognosis; prospective study; risk assessment; risk factor; standing; supine position; symptom; systolic blood pressure; blood pressure; blood pressure measurement; diagnosis; epidemiology; middle aged; outpatient; pathophysiology; physiology; procedures; standing; very elderly
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