Orthostatic Hypotension and Mortality in Elderly Frail Patients

Abstract

Orthostatic hypotension (OH) is a common problem in the elderly age group, and some studies have reported an association between OH and increased mortality. We evaluated possible associations between OH and mortality in a retrospective study of frail elderly patients who came for a comprehensive geriatric assessment.The study included all patients ≥65 years who were assessed in the outpatient Comprehensive Geriatric Assessment Unit. Data were collected from the computerized medical record, including blood pressure, sociodemographic data, lifestyle, falls, pulse rate, body mass index, functional and cognitive status, and comorbidity. Data on mortlaity were also collected.The study population consisted of 571 patients who underwent assessment over a 9-year study period. The mean age was 83.7 ± 6.1, 35.9% were males, and 183 (32.1%) were diagnosed with OH. Systolic OH (OHS) was more common than diastolic OH (25.2% vs 15.6%). In univariate analyses, OHS was associated with increased overall mortality. Over the follow-up period, 30.2% of the OHS patients died compared with 22.3% (P = 0.037), but in the Cox models there was no statistically significant associations between OHS and overall mortality. In contrast, age, burden of comorbidity, a low high-density lipoprotein level, and low creatinine clearance were independent predictors of increased overall mortality.In a population of frail elderly patients with a high burden of comorbidity, OH was not an independent risk factor for overall mortality.

Orthostatic hypotension and overall mortality in 1050 older patients of the outpatient comprehensive geriatric assessment unit

“…In the present retrospective study, in both the total study population of 1050 patients treated at the OCGAU and the subgroups (626 patients who underwent CGA and 424 who underwent GC), no significant association was found in the multivariate analyses between OH and overall mortality. These results are similar to our previous findings in a sample of 571 patients, but in the present study some of the patients were less complicated in geriatric terms and only underwent GC. In a meta‐analysis, Xin et al reached the conclusion that the association between OH and overall mortality is less striking in retrospective studies, if they are not community‐based, have OH rates >20% and adjust for classic cardiovascular diseases .…”

“…It should be noted that 571 of the 626 CGA patients were already included in our previous study . The mean age of the study population was 77.3 ± 5.4 years, and 375 (35.7%) were men.…”

“…[12][13][14] In a retrospective study of 571 frail older adults who underwent a comprehensive geriatric assessment (CGA) over the years 2005-2013, we did not find any association between OH and mortality. 15 The aim of the present study was to assess possible associations between OH and mortality in a broader sample that included not only patients who underwent CGA, but also those who underwent a geriatric consultation (GC) in the same unit. and at times a dietician and/or a occupational therapist, or whether the assessment can be limited to a more limited GC.…”

The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

“…Of these, 571 (90.9%) had blood pressure (BP) measurements that enabled calculation of OH, as described in a previous paper. [29] The prevalence of OH was 32.1%. There were MMSE scores for 534 patients (85 % of the entire study population of 571 patients): 172 with OH (mean MMSE score = 22.5 ± 5.2) and 362 without OH (mean MMSE score = 21.6 ± 5.8) ( P  = 0.09).…”

Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a ‘sit-to-stand test’

“…The presence of OH has significant consequences that are still being understood; overall, it is associated with an increased risk of morbidity and mortality [2–5]. OH can be caused by acute conditions including hypovolemia, valvular heart disease, and acute illness, as well as a host of chronic disorders including diabetes, Parkinson’s disease, and multiple system atrophy [6].…”