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

•A multicenter prospective observational study was performed to estimate orthostatic blood pressure responses in hospitalized and ambulatory patients with heart failure (HF) by using standardized methodology.•Independent of study settings, 11%–22% of patients with HF experienced classic orthostatic...

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Published in:	Journal of cardiac failure Vol. 30; no. 7; pp. 890 - 903
Main Authors:	Soloveva, Anzhela, Fedorova, Darya, Fudim, Marat, Vinogradova, Nadezhda, Chemodanova, Alena, Kozlova, Anastasia, Fomin, Igor, Skuratova, Mariya, Shneidmiller, Natalia, Golovina, Galina, Kosmacheva, Elena, Gubareva, Ekaterina, Teterina, Marina, Godunko, Elena, Chesnikova, Anna, Okunev, Igor, Kashtalap, Vasily, Kuznetsova, Mariia, Dzhioeva, Olga, Kopeva, Kristina, Zvartau, Nadezhda, Villevalde, Svetlana
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2024
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Summary:	•A multicenter prospective observational study was performed to estimate orthostatic blood pressure responses in hospitalized and ambulatory patients with heart failure (HF) by using standardized methodology.•Independent of study settings, 11%–22% of patients with HF experienced classic orthostatic hypotension, and 3%–8% experienced orthostatic hypertension.•Patients with HF report variable symptoms during an active standing test; they occur predominantly during the first minute of standing and have a U-shaped association with postural changes in blood pressure.•Up to 50% of cases with an abnormal orthostatic blood pressure response are asymptomatic.•Orthostatic hypotension in ambulatory patients with HF is associated with a higher risk of death or hospitalization due to HF. 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). 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. 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. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1071-9164 1532-8414 1532-8414
DOI:	10.1016/j.cardfail.2023.12.017