The association between orthostatic blood pressure changes and subclinical target organ damage in subjects over 60 years old

Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events,the underlying mechanisms are still controversial.The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old.Methods This is a prospective observational cohort study.One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled.Participants were grouped according to whether they had a drop>20 mmHg in systolic or>10 mmHg in diastolic BP(orthostatic hypotension),an increase in mean orthostatic systolic blood pressure>20 mm Hg(orthostatic hypertension),or normal changes within 3 min of orthostatism.Multiple regression modeling was used to investigate the relationship between orthostatic hypotension,orthostatic hypertension and subclinical organ damage with adjustment for confounders.Results Orthostatic hypotension and orthostatic hypertension were found in 461(23.1%)and 189(9.5%)participants,respectively.Measurement of carotid intima-media thickness(IMT),brachial-ankle pulse wave velocity(baPWV),clearance of creatinine,and microalbuminuria were associated with orthostatic hypotension;measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model.After adjustment,IMT[odds ratio(OR),95%confidence interval(CI)per one-SD increment:1.385,1.052-1.823;P=0.02],baPWV(OR=1.627,95%CI:1.041-2.544;P=0.033)and microalbuminuria(OR=1.401,95%CI:1.002-1.958;P=0.049)were still associated with orthostatic hypotension,while orthostatic hypertension was only associated with IMT(OR=1.730,95%CI:1.143-2.618;P=0.009).Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis,arterial stiffness and renal damage in subjects over 60 years old.Orthostatic hypertension correlates with carotid atherosclerosis only.

Fifteen-year mortality and prognostic factors in patients with dilated cardiomyopathy:persistent standardized application of drug therapy and strengthened management may bring about encouraging change in an aging society

BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated car-diomyopathy(DCM).The study aimed to investigate the all-cause mortality up to 15 years(mean 7.9±5.7 years)in such patients,and the independent prognostic factors influencing their long-term mortality.METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003.The mean age of patients was 59.5±10.4 years,and approximately 57%were male.They were followed up by telephone or outpa-tient visit at least every three months until 2019 or all-cause death occurred.Predictors of mortality were identified using mul-tivariate logistic regression analysis.RESULTS During the 15 years of follow-up,five patients were lost to follow-up,and the complete data records of 161 patients were included in the analysis.Patients were treated with angiotensin-converting-enzyme inhibitors(ACEI)or angiotensin-recept-or blocker(ARB),β-blockers,mineralocorticoid receptor antagonist(MRA),diuretics and digitalis from 2002 to 2004,and main-tained at the maximum tolerated doses between 2004 and 2019.Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg,respectively.All-cause mortality in the first five years was 55.9%.The independent risk factors for the 5-year mortality were age≥70 years old(OR=5.45,P=0.006),systolic blood pressure(SBP)>120 mmHg(OR=3.63,P=0.004),6-minute walk distance(6MWD)<450 m(OR=3.84,P=0.001).15-year all-cause mortality was 65.8%.The inde-pendent risk factors for 15-year mortality were age≥70 years old(OR=16.07,P=0.009),LVEF≤35%(OR=5.69,P=0.003),and SBP>120 mmHg(OR=9.56,P<0.001).CONCLUSIONS This study was the first to demonstrate the 15-year survival rate of 34%in DCM patients.The DCM patients’first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management.The mortality then plateaued in the following 10 years.Age≥70 years,LVEF≤35%,and SBP>120 mmHg were independent predict-ors of 15-year all-cause mortality.