Table 3.
Factors significantly associated with the development of hypotension in patients newly diagnosed with heart failure
| Controls (n=5102) |
Cases with hypotension (n=2551) | OR* | 95% CI | |||
| n | % | n | % | |||
| Lifestyle factors | ||||||
| BMI (kg/m2) | ||||||
| 11–19.99 | 221 | 4.3 | 155 | 6.1 | 1.20 | 0.94 to 1.54 |
| 20–24.99 | 1137 | 22.3 | 691 | 27.1 | 1 | – |
| 25–29.99 | 1701 | 33.3 | 817 | 32.0 | 0.76 | 0.66 to 0.88 |
| ≥30 | 1560 | 30.6 | 670 | 26.3 | 0.64 | 0.55 to 0.74 |
| Unknown | 483 | 9.5 | 218 | 8.5 | 0.73 | 0.59 to 0.90 |
| Healthcare utilisation | ||||||
| PCP visits† | ||||||
| 0–3 | 105 | 2.1 | 17 | 0.7 | 1 | – |
| 4–9 | 771 | 15.1 | 208 | 8.2 | 1.32 | 0.76 to 2.30 |
| ≥10 | 4226 | 82.8 | 2326 | 91.2 | 2.29 | 1.34 to 3.90 |
| Referrals† | ||||||
| None | 1022 | 20.0 | 355 | 13.9 | 1 | – |
| 1–3 | 1900 | 37.2 | 873 | 34.2 | 1.20 | 1.02 to 1.41 |
| ≥4 | 2180 | 42.7 | 1323 | 51.9 | 1.41 | 1.20 to 1.65 |
| Hospitalisations† | ||||||
| None | 3487 | 68.3 | 1409 | 55.2 | 1 | – |
| ≥1 | 1615 | 31.7 | 1142 | 44.8 | 1.53 | 1.37 to 1.71 |
| Cardiovascular comorbidities‡ | ||||||
| Hypotension antecedents | 160 | 3.1 | 210 | 8.2 | 2.32 | 1.84 to 2.92 |
| 1 episode | 131 | 2.6 | 155 | 6.1 | 2.09 | 1.61 to 2.71 |
| ≥2 episodes | 29 | 0.5 | 55 | 2.1 | 3.31 | 2.06 to 5.34 |
| Ischaemic heart disease | 2940 | 57.6 | 1688 | 66.2 | 1.36 | 1.22 to 1.53 |
| Myocardial infarction | 1519 | 29.8 | 1009 | 39.6 | 1.35 | 1.20 to 1.52 |
| Stable angina | 1671 | 32.8 | 967 | 37.9 | 1.14 | 1.01 to 1.28 |
| Unstable angina | 363 | 7.1 | 269 | 10.5 | 1.25 | 1.03 to 1.52 |
| Valvular cardiac disease | 612 | 12.0 | 378 | 14.8 | 1.19 | 1.03 to 1.38 |
| Hyperlipidaemia | 1419 | 27.8 | 800 | 31.4 | 1.15 | 1.02 to 1.30 |
| Hypertension | 3080 | 60.4 | 1255 | 49.2 | 0.59 | 0.52 to 0.66 |
| Other specific comorbidities‡ | ||||||
| Renal failure§ | ||||||
| No (eGFR >60 mL/min/1.73 m2) | 1816 | 35.6 | 707 | 27.7 | 1 | – |
| eGFR 45–59 mL/min/1.73 m2 | 1324 | 26.0 | 648 | 25.4 | 1.16 | 1.00 to 1.33 |
| eGFR 30–44 mL/min/1.73 m2 | 1005 | 19.7 | 635 | 24.9 | 1.44 | 1.23 to 1.68 |
| eGFR <30 mL/min/1.73 m2 | 439 | 8.6 | 342 | 13.4 | 2.01 | 1.66 to 2.43 |
| eGFR not recorded | 518 | 10.2 | 219 | 8.6 | 1.23 | 0.99 to 1.52 |
| Diabetes | 1334 | 26.1 | 642 | 25.2 | 0.85 | 0.75 to 0.96 |
| Infections¶ | ||||||
| Respiratory | 497 | 9.7 | 2962 | 11.6 | 1.31 | 1.12 to 1.52 |
| Genitourinary | 114 | 2.2 | 91 | 3.6 | 1.64 | 1.21 to 2.23 |
| Hypothyroidism | 508 | 10.0 | 318 | 12.5 | 1.18 | 1.00 to 1.39 |
| Anaemia¶ | 215 | 4.2 | 151 | 5.9 | 1.35 | 1.07 to 1.71 |
| Liver disease | 127 | 2.5 | 82 | 3.2 | 1.36 | 1.00 to 1.85 |
| COPD | 968 | 19.0 | 512 | 20.1 | 1.18 | 1.03 to 1.36 |
| Depression¶ | 214 | 4.2 | 159 | 6.2 | 1.61 | 1.28 to 2.03 |
| Dementia | 117 | 2.3 | 77 | 3.0 | 1.55 | 1.12 to 2.16 |
| Cardiovascular drugs** | ||||||
| Diuretics†† | 3741 | 73.3 | 2138 | 83.8 | 1.49 | 1.24 to 1.80 |
| Aldosterone antagonists | 747 | 14.6 | 864 | 33.9 | 2.54 | 2.23 to 2.90 |
| ACE inhibitors | 2906 | 57.0 | 1665 | 65.3 | 1.68 | 1.44 to 1.95 |
| ARBs | 869 | 17.0 | 456 | 17.9 | 1.33 | 1.12 to 1.58 |
| CCBs†† | 1130 | 22.1 | 398 | 15.6 | 0.77 | 0.67 to 0.89 |
| Beta-blockers | 1968 | 38.6 | 1155 | 45.3 | 1.14 | 1.01 to 1.29 |
| Nitrates | 1194 | 23.4 | 792 | 31.0 | 1.24 | 1.08 to 1.43 |
| Other drugs** | ||||||
| Antidepressants | 740 | 14.5 | 484 | 19.0 | 1.36 | 1.18 to 1.57 |
| Opioids | 592 | 11.6 | 372 | 14.6 | 1.24 | 1.06 to 1.45 |
| Antidiabetics | 934 | 18.3 | 432 | 16.9 | 0.79 | 0.68 to 0.91 |
*The OR was adjusted for PCP visits, use of antihypertensive medications (thiazides and related diuretics, loop diuretics, aldosterone antagonists, ACE inhibitors, ARBs, CCBs, and beta-blockers), hypertension, renal failure, ischaemic heart disease, and valvular cardiac disease.
†Healthcare utilisation in the year before the index date was assessed.
‡The reference category was the absence of the corresponding comorbidity.
§Renal function was ascertained by searching for serum creatinine measurements any time before the index date and taking the closest valid serum creatinine value. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation.
¶Anaemia and depression were assessed in the year before the index date and infections in the 3 months before the index date.
**Current use (0–30 days before the index date) was compared with never use as the reference category.
††Other subtypes of diuretics (thiazide and loop diuretics) and subtypes of CCBs (dihydropyridines and non-dihydropyridines (verapamil and diltiazem)) are presented in online supplementary table S2.
ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BMI, body mass index; CCB, calcium channel blocker; CI, confidence interval; COPD, chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate; OR, odds ratio; PCP, primary care physician.