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Relationship Between the Drop Rate of Standing Blood Pressure and Major Adverse Cardiovascular Events
Wenqin Cai1,2,3,4,5, Yuexian Yao6, Suli Zheng1,2
1Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Insights
Orthostatic hypotension (OH) is a drop in blood pressure upon standing. A faster drop rate, defined as systolic BP drop ≥15% or diastolic BP drop ≥5%, predicts major adverse cardiovascular events and mortality in hospitalized patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Hypertension Research
Background:
- Orthostatic hypotension (OH) is characterized by a significant drop in blood pressure within 3 minutes of standing.
- Existing research links OH to increased risks of major adverse cardiovascular events (MACEs) and mortality.
- The prognostic value of the orthostatic blood pressure (BP) drop rate for MACEs and mortality remains unexplored.
Purpose of the Study:
- To investigate the relationship between the rate of orthostatic blood pressure (BP) drop and the risk of MACEs and mortality.
- To establish novel diagnostic thresholds for OH based on BP drop rate.
- To evaluate the predictive accuracy of the proposed OH diagnostic criteria for adverse cardiovascular outcomes.
Main Methods:
- A cohort of 448 hospitalized patients with a median follow-up of 5.09 years.
- Patients were categorized into high (systolic BP drop rate ≥15% and/or diastolic BP drop rate ≥5%) and normal BP drop rate groups.
- Statistical analyses included Chi-square tests, Kaplan-Meier survival analysis, ROC analysis, and Cox regression.
Main Results:
- The high BP drop rate group exhibited significantly higher risks of MACEs and mortality compared to the normal BP drop rate group (p < 0.05).
- The proposed diagnostic threshold (systolic BP drop ≥15% and/or diastolic BP drop ≥5% within 3 min) showed high accuracy (AUC=0.918) for OH diagnosis.
- Cox regression confirmed a significantly higher cumulative survival rate in the normal BP drop rate group (98.45% vs. 93.69%, HR=0.304, p=0.044).
Conclusions:
- A rapid orthostatic blood pressure drop rate (systolic BP drop ≥15% and/or diastolic BP drop ≥5% within 3 min) is a significant predictor of MACEs and mortality.
- This study proposes a novel, accurate diagnostic criterion for OH with prognostic implications in hospitalized patients.
- The findings highlight the importance of assessing BP drop rate for risk stratification and management of cardiovascular outcomes.
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 BPdrop_rate_high group (defined as SBP drop rate 15% and/or DBP drop rate 5% within 3 min after standing) and the BPdrop_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 BPdrop_rate_high group had a higher risk of MACEs and mortality than the BPdrop_rate_normal group (all p 0.05). The Receiver Operating Characteristic (ROC) analysis demonstrated SBP drop rate 15% and/or DBP drop rate 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 BPdrop_rate_normal group was significantly higher than that of the BPdrop_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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