Juvenile haemochromatosis in a 30-year old patient with heterozygous beta-thalassemia
Tijmensen, J.E., Houten, H. van
Voorzitter(s): mw. prof.dr. J. de Graaf, Nijmegen & mw. dr. E.J.M. Mattijssen, Arnhem
Locatie(s): Auditorium 2
Categorie(ën):
Introduction: Normally, standing up causes a blood pressure drop within 15 seconds, followed by recovery to baseline driven by blood pressure control mechanisms. The prognostic value of this initial blood pressure drop, but also of the recovery hereafter, is unknown.
Aim: The aim of this study was to examine the prognostic value of these blood pressure characteristics in response to standing.
Methods: In a cohort study of 238 consecutive patients visiting our falls outpatient clinic, we examined the relation between all-cause mortality and blood pressure decline and recovery directly after active standing up with Cox proportional hazards analyses.
Results: Of 238 patients (mean age 78.4 ± 7.8 years), during a median follow-up of 21.0 months, 36 (15%) patients died. Neither absolute nor relative (%) initial blood pressure drop after standing predicted mortality. In contrast, the magnitude of blood pressure recovery 40 to 60 seconds after standing was associated with mortality, even after adjustment for age, co-morbidity and other baseline characteristics. When systolic blood pressure had recovered to less than 80% of pre-standing baseline after 60 seconds of standing, this was a powerful independent predictor of mortality (hazard ratio: 3.00; 95% confidence interval: 1.17-7.68).
Conclusions:
Failure to recover from blood pressure decline in the first minute after active standing up is associated with excess mortality in falls clinic patients. A recovery of systolic blood pressure to less than 80% of baseline after 60 seconds may be used as an easy available cardiovascular marker for increased mortality risk in older falls clinic patients.