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 heart failure (HF) patients.

Methods and Results

321 active standing tests were performed in 87 inpatients during admission and 316 tests were done in 208 outpatients during follow-up. Blood pressure (BP) was measured by an automatic device 4 times in supine position and at 1, 3 and 5 min 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 an abnormal response were asymptomatic. Symptoms were variable and mainly occurred during first minute of standing and had a U-shaped association with BP changes. OH in HF outpatients was associated with a higher risk of death or HF readmission.

Conclusions

Patients with HF have variable hemodynamic responses and symptoms during repeated active standing tests. OH might identify HF outpatients at risk of long-term negative outcomes.

中文翻译：

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住院和门诊心力衰竭患者主动站立测试期间的血压反应和症状：GRAVITY-HF 前瞻性观察队列研究的结果

背景

我们进行了一项多中心前瞻性观察研究，以描述直立性低血压 (OH) 和直立性高血压 (OHtn) 的发生率及其与心力衰竭 (HF) 患者站立症状和结局的关系。

方法和结果

入院期间对 87 名住院患者进行了 321 次主动站立测试，在随访期间对 208 名门诊患者进行了 316 次主动站立测试。通过自动装置在仰卧位和站立 1、3 和 5 分钟时测量血压 (BP) 4 次。询问患者体位不耐受的症状。

两组基线时 OH 和 OHtn 的发生率相似（经典 OH 11-22%，OHtn 3-8%，具体取决于定义和时间）。站立时血压变化的再现性较低。高达 50% 的异常反应病例是无症状的。症状多种多样，主要发生在站立的第一分钟，并且与血压变化呈 U 形关联。心力衰竭门诊患者的 OH 与死亡或心力衰竭再入院的较高风险相关。

结论

心力衰竭患者在重复的主动站立测试中具有不同的血流动力学反应和症状。OH 可能会识别出有长期负面结果风险的心力衰竭门诊患者。