Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

Abstract

Abstract-In old individuals, regulation of blood pressure during postural changes is impaired. Several studies have assessed the clinical impact of orthostatic hypotension (OHypoT) during the aging process. By contrast, the prevalence and prognostic role of the increase in blood pressure in upright position (orthostatic hypertension, OHyperT) in old adults remain unknown. We investigated the association of OHyperT with cardiovascular morbidity and mortality in a population of old institutionalized subjects. A 2-year follow-up longitudinal study was conducted on 972 subjects ( In conclusion, in a old frail population, the increase in systolic blood pressure during upright position occurs frequently and is associated with higher cardiovascular morbidity and mortality independently of sitting blood pressure levels and major comorbidities. Health professional should take into account not only the decrease but also the increase in blood pressure when standing up. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901355.

Hypertension Management in Older and Frail Older Patients

“…Modifications in orthostatic BP have been shown to affect the prognosis of older people 30,31 by increasing the risk of syncope and falls, leading to hospitalization and functional impairment, 32,33 in addition to increasing CVD and all-cause mortality. 31,34 Somewhat paradoxically, orthostatic reactions may be alleviated with better hypertension control.…”

“…40 We have moreover recently reported that orthostatic hypertension in very old subjects living in NHs was related to an increased risk of CVD morbidity/mortality in a manner similar to that observed with orthostatic hypotension. 30…”

Locomotive syndrome is associated with large blood pressure variability in elderly hypertensives: the Japan Ambulatory Blood Pressure Prospective (JAMP) substudy

“…26 However, in a general elderly population, orthostatic hypertension was associated with higher CV risk independently of sitting BP levels. 27 We demonstrated that orthostatic hypertension is a new hemodynamic CV risk factor. 28 Another recent study indicated that orthostatic hypertension is a predisposing factor for masked hypertension in healthy individuals.…”

“…[23][24][25] It was recently reported that orthostatic hypertension occurs frequently among frail elderly individuals. 26,27 A study of acute hospitalized patients revealed that orthostatic hypertension was associated with favorable outcomes. 26 However, in a general elderly population, orthostatic hypertension was associated with higher CV risk independently of sitting BP levels.…”

Hypertension in the frail elderly

“…Other measures of frailty include both orthostatic hypotension and orthostatic hypertension (14). Patients with either finding had an increased risk of cardiovascular mortality.…”