ORTHOSTATIC HYPOTENSION PREDICTS THE EARLY MORBIDITY AND MORTALITY IN PATIENTS WITH ISCHEMIC HEART DISEASE IN CORONARY CARE UNIT

Abstract

Background: The mechanism by which the orthostatic hypotension and cardiac autonomic neuropathy increase cardiovascular morbidity and mortality remain to be settled. Some studies found exercise intolerance in patients with cardiac autonomic neuropathy with a reduced response in heart rate and blood pressure and decreased cardiac output during exercise. An association between cardiac autonomic neuropathy and QT prolongation has been shown. Objective: To asses the role of the orthostatic hypotension in the development of the early cardiovascular complications in the patients of the coronary care unit. Patients and method: In this a prospective observational follow up study, (50) patients with ischemic heart diseases were included. Blood pressure was measured with the standard mercury sphygmomanometer, the measurement in supine position was taken after at least 15 minutes of rest and the measurement in standing position was taken at the third minutes of standing, the orthostatic hypotension is said to be present when there was a sustained drop in systolic (≥ 20 mmHg) or diastolic (≥ 10 mmHg) blood pressure at the third minute of standing up. Results: Out of twenty two patients with orthostatic hypotension fifteen patients developed cardiovascular complications and out of twenty eight patients without orthostatic hypotension five patients developed cardiovascular complications, this association is statistically significant Conclusion: Orthostatic hypotension can be used as a prognostic marker for the development of early adverse outcomes in patients with acute coronary syndrome, thus it can be useful tool to screen the high risk patients in the coronary care unit. Key words: orthostatic hypotension, complication of MI, IHD, DM. Abbreviations: ACE – I: angiotensin converting enzyme inhibitor ARBs     : angiotensin receptor blockers OH        : orthostatic hypotension