Orthostatic Changes in Blood Pressure and Mortality in the Elderly: The Pro.V.A Study

Veronese, Nicola; Rui, Marina De; Bolzetta, Francesco; Zambon, Sabina; Corti, Maria Chiara; Baggio, G.; Toffanello, Elena Debora; Maggi, Stefania; Crepaldi, Gaetano; Perissinotto, Egle; Manzato, Enzo; Sergi, Giuseppe

doi:10.1093/ajh/hpv022

Cited by 72 publications

(74 citation statements)

References 29 publications

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“…These data are consistent with what we expected as all the studies included were made in older persons in which these two conditions are highly prevalent as suggested by other surveys about these topics [1,3,25,26].…”

Section: Discussionsupporting

confidence: 92%

Hypovitaminosis D and orthostatic hypotension

Ometto¹,

Stubbs²,

Annweiler³

et al. 2016

Journal of Hypertension

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Section: Discussionsupporting

confidence: 92%

Hypovitaminosis D and orthostatic hypotension

Ometto¹,

Stubbs²,

Annweiler³

et al. 2016

Journal of Hypertension

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“…21 These analyses were conducted primarily on hypertensive subjects, including young adults and older people. 22 To our knowledge, this the first study to prospectively indicate an association between OHyperT and strong cardiovascular outcome in a old frail institutionalized population. In a previous study involving this population, we showed higher mortality rates in individuals with lower SBP levels, 23 especially in those receiving >1 antihypertensive medications.…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2016

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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.

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“…Although several observational studies have shown that OH is associated with CVD events12, 13, 14, 15, 16, 17 and mortality,14, 18 others have shown no relationship 7, 8, 9, 10. Along these lines, in a secondary analysis of the ACCORD, Fleg and colleagues 11 demonstrated that OH was not associated with CVD events.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Juraschek

Daya

Appel

et al. 2018

JAHA

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BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial.Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49).Conclusions OH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.

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Orthostatic Changes in Blood Pressure and Mortality in the Elderly: The Pro.V.A Study

Abstract: Orthostatic hypertension and hypotension both seem to be relevant risk factors for mortality in the elderly, orthostatic hypertension correlating with all-cause and CVD-related mortality and orthostatic hypotension with non-CVD mortality.

Cited by 72 publications

References 29 publications

Hypovitaminosis D and orthostatic hypotension

Hypovitaminosis D and orthostatic hypotension

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

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

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