The association of abnormal orthostatic blood pressure variability with heart failure and frailty in the elderly

2023 Fiscal Year Final Research Report

• Project/Area Number: 19K12829
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 90130:Medical systems-related
• Research Institution: Jichi Medical University
• Principal Investigator: Kenji Harada 自治医科大学, 医学部, 准教授 (10815012)
• Co-Investigator(Kenkyū-buntansha): 星出 聡 自治医科大学, 医学部, 教授 (90326851) ; 苅尾 七臣 自治医科大学, 医学部, 教授 (60285773)
• Project Period (FY): 2019-04-01 – 2024-03-31
• Keywords: 血圧変動異常 / 心不全 / 起立性高血圧 / フレイル

Outline of Final Research Achievements

We investigated the association of orthostatic hypertension and frailty with prognosis, including rehospitalization within 1 year after discharge and all-cause mortality, in elderly HFpEF patients admitted to our hospital (70 patients, 36 women, age 77.8 ± 7.6 years). The orthostatic blood pressure variability were measured after 3 minutes of supine rest and after 3 minutes of standing. Other variables such as frailty, cognitive decline (MMSE), serum Cr, high NT-pro BNP (>900 pg/ml) at discharge, and GLS (strain index of left ventricular contractility) were added for multivariate analysis. High NT-pro BNP and blood pressure difference before and after orthostasis were predictive factors for both rehospitalization within one year and all-cause mortality. The results suggest that elevated blood pressure during orthostasis may play a role in the prognosis of patients with HFpEF.

Free Research Field

心不全

Academic Significance and Societal Importance of the Research Achievements

高齢化に伴い増加する心不全は高血圧に伴う左室収縮力が保たれた心不全(HFpEF)の割合が多いとされる。しかしHFpEFのメカニズムは不明な点も多く、確立した治療法もない。さらに心不全に高齢者特有のフレイルが加わることで予後や健康寿命の短縮につながるとされる。日常生活の中で最も頻繁な動作である起立に伴う血圧変動の異常である起立性高血圧は高齢者特有の血圧変動性の増大を反映する。この起立性高血圧は交感神経亢進や後負荷増大にもたらされるものでありHFpEF発症と関連がある可能性がある。今回の研究で起立性高血圧がHFpEFの発症との関連が示された。新たな心不全発症の危険因子として研究していく必要がある。