Orthostatic hypotension predicts incidence of heart failure: the Malmö preventive project

The presence of orthostatic hypotension (OH) predicts all-cause mortality and incident cardiovascular disease. Whether or not OH is associated with the development of heart failure (HF) remains unknown.

In this Swedish population-based prospective study (the Malmö Preventive Project), the incidence of HF in relation to baseline OH, defined as decrease in systolic (SBP) ≥20 mm Hg and/or diastolic blood pressure (DBP) ≥10 mm Hg upon standing, was studied in 32,669 middle-aged individuals (68.2% men; mean age, 45.6 ± 7.4 years) over a mean follow-up period of 24 years.

At baseline, 1,991 (6.1%) participants were found to have OH. During follow-up, 1,293 persons (4.0%, mean age at presentation: 67.9 ± 7.9 years) were hospitalized for HF, 912 (2.8%) of whom without previous or concurrent myocardial infarction (MI) ("nonischemic HF"). Among those who had OH, the corresponding numbers were 6.5% (n = 129) and 4.6% (n = 92), respectively. In multivariable Cox proportional hazard models, taking conventional HF risk factors into account, OH was associated with both all-cause and "nonischemic" HF events (hazard ratio (HR): 1.22, 1.01-1.46, and 1.31, 1.05-1.63, respectively). The association between OH and HF was more pronounced in younger (aged <45 years) than older individuals (2.05; 1.31-3.22 vs. 1.12, 0.92-1.38, respectively, P < 0.001 for interaction between age and OH on incident HF).

The presence of OH among middle-aged adults predicts long-term incidence of HF hospitalizations independently of conventional risk factors. Our findings add to the available data indicating that OH is a potential independent cardiovascular risk factor, especially with regard to younger individuals and nonischemic HF.