Orthostatic hypotension and mortality risk: a meta-analysis of cohort studies

Wei, Xin; Lin, Zhiqin; Mi, Shuhua

doi:10.1136/heartjnl-2013-304121

Cited by 90 publications

(73 citation statements)

References 37 publications

(60 reference statements)

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“…1 Symptoms include lightheadedness, fatigue, neck pain, presyncope, and syncope. 2,3 The causes can include both CNS and peripheral nervous system degeneration. 4 Dopamine replacement therapies have been implicated as well.…”

Section: Discussionmentioning

confidence: 99%

Effects of orthostatic hypotension on cognition in Parkinson disease

et al. 2017

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Objective: To investigate the relation between orthostatic hypotension (OH) and posturemediated cognitive impairment in Parkinson disease (PD) using a cross-sectional and withingroup design.Methods: Individuals without dementia with idiopathic PD included 18 with OH (PDOH) and 19 without OH; 18 control participants were also included. Neuropsychological tests were conducted in supine and upright-tilted positions. Blood pressure was assessed in each posture. Results:The PD groups performed similarly while supine, demonstrating executive dysfunction in sustained attention and response inhibition, and reduced semantic fluency and verbal memory (encoding and retention). Upright posture exacerbated and broadened these deficits in the PDOH group to include phonemic fluency, psychomotor speed, and auditory working memory. When group-specific supine scores were used as baseline anchors, both PD groups showed cognitive changes following tilt, with the PDOH group exhibiting a wider range of deficits in executive function and memory as well as significant changes in visuospatial function. Conclusions:Cognitive deficits in PD have been widely reported with assessments performed in the supine position, as seen in both our PD groups. Here we demonstrated that those with PDOH had transient, posture-mediated changes in excess of those found in PD without OH. These observed changes suggest an acute, reversible effect. Understanding the effects of OH due to autonomic failure on cognition is desirable, particularly as neuroimaging and clinical assessments collect data only in the supine or seated positions. Identification of a distinct neuropsychological profile in PD with OH has quality of life implications, and OH presents itself as a possible target for intervention in cognitive disturbance. Orthostatic hypotension (OH) is among the most commonly reported nonmotor manifestations in persons with Parkinson disease (PD), with prevalence as high as 53%.1 Symptoms include lightheadedness, fatigue, neck pain, presyncope, and syncope.2,3 The causes can include both CNS and peripheral nervous system degeneration.4 Dopamine replacement therapies have been implicated as well. 5OH is associated with cognitive impairment. Even when controlling for systolic blood pressure (SBP), both elderly and younger individuals with OH show relative deficits in verbal memory and sustained attention, both of which are predictors of subsequent cognitive decline that is greater than would be expected in the context of normal aging. 6Idiopathic PD is itself associated with cognitive deficits. Historically, these were thought to be limited to psychomotor/information processing speeds and caused by disease-specific subcortical pathologies.7 However, deficits across executive functions are present, even in cases without

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Section: Discussionmentioning

confidence: 99%

Effects of orthostatic hypotension on cognition in Parkinson disease

et al. 2017

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“…12 While in unselected community-based studies OH has a lower but still significant morality risk, [13][14][15][16] a recent meta-analysis of these cohort studies reported a significant all-cause mortality-adjusted risk ratio of 1.4. 17 The mechanism underlying the increased mortality and the cause of death in most of these studies is not known and is likely to vary with the underlying population under study.…”

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confidence: 99%

Clinical implications of delayed orthostatic hypotension

2015

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Objective: To define the long-term outcome of delayed orthostatic hypotension (OH).Hypothesis: Delayed OH is an early and milder form of OH that progresses over time. Methods:We reviewed the medical records of 230 previously reported patients who completed autonomic testing at our center from January 1, 2002, through December 31, 2003. All available information on clinical diagnosis, mortality, medication use, and autonomic testing were extracted and included in the reported outcomes. Standard criteria were used to define OH and delayed OH.Results: Forty-eight individuals with delayed OH, 42 individuals with OH, and 75 controls had complete follow-up data. Fifty-four percent of individuals with delayed OH progressed to OH. Thirty-one percent of individuals with delayed OH developed an a-synucleinopathy. The 10-year mortality rate in individuals with delayed OH was 29%, in individuals with baseline OH was 64%, and in controls was 9%. The 10-year mortality of individuals who progressed to OH was 50%. Progression to OH was associated with developing an a-synucleinopathy, baseline diabetes, and abnormal baseline autonomic test results.Conclusion: Delayed OH frequently progresses to OH with a high associated mortality. Orthostatic hypotension (OH) is a reduction in systolic blood pressure (BP) of at least 20 mm Hg or diastolic BP of at least 10 mm Hg within 3 minutes of standing, or a similar fall in BP within 3 minutes of upright tilt-table testing to at least 60°. However, the duration of time necessary to detect a fall in BP that is clinically meaningful may extend beyond 3 minutes. Over 20 years ago, Streeten and Anderson 1 introduced the concept of delayed OH (DOH)-a BP fall on standing or upright tilt-table testing that occurred after the 3-minute cutoff. We extended those findings in a report documenting that DOH occurred with the same frequency as OH in a population of individuals referred for autonomic testing.2 In addition, DOH was associated with both parasympathetic and sympathetic adrenergic dysfunction, although of less severity than in those individuals with a fall in BP within 3 minutes of standing or tilt-table testing.DOH is now widely recognized among specialists as a potential cause of orthostatic intolerance and is included in a recent consensus statement on disorders of orthostatic intolerance. However, despite several cross-sectional studies of individuals with DOH, there are no longitudinal data available.1,2,4 Further, it is not known whether DOH is an early presentation of OH, or whether it is a more benign or nonprogressive form of orthostatic intolerance.We hypothesized that DOH was an early and milder form of OH. We therefore expected that DOH would progress to OH over time, would be associated with similar underlying disease mechanisms, and would have similar long-term complications. In order to investigate these hypotheses, we reviewed the medical records of all individuals reported in our original DOH study. 2 Here, we present the 10-year follow-up data of the groups described ...

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“…Evidence is accumulating to show that OH is associated with a higher risk of future mortality (7,8,(16)(17)(18), although the previous results have not been consistent (30,31). One meta-analysis indicated that subjects with OH were associated with a 40% higher risk of future all-cause mortal-ity (32). One previous report has shown that orthostatic BP variability may be a better indicator of future stroke than a single supine or orthostatic change measure (33).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, OH may lead to a higher mortality risk, partially through the impact of these classic risk factors. Second, subjects with OH are likely to have increased BP variability related to body posture, and a large proportion of the thoracic blood volume may be displaced to the lower limbs due to gravity during orthostasis, which may lead to serious ischemia of important organs, such as the heart, brain and kidney (32). Third, baroreflex dysfunction, a marker of autonomic nervous system imbalance implicated in the pathogenesis of OH, is characterized by enhanced sympathetic activity and the withdrawal of parasympathetic control and has been well recognized to be an important mediator of increased cardiovascular morbidity and mortality (34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension Predicts a Poor Prognosis in Elderly People with Dementia

Oishi¹,

Sakata

Tsuchihashi

et al. 2016

Intern. Med.

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Objective The purpose of the present study was to assess the prevalence of orthostatic hypotension (OH) and elucidate its associations with the demographic characteristics and the prognosis in elderly subjects with dementia who visited a hospital for elderly daycare. Methods A total of 64 outpatients (44 females) with a mean age of 84 6 years who visited a hospital for daycare were enrolled in the study. The prevalence of OH and demographic characteristics were examined. Then, the subjects were followed up for 1 year. The blood pressure was measured in the supine position and immediately, 1, 3 and 5 minutes after standing. Poor outcome measures included death, hospitalization for any reason, and admission to a nursing home or geriatric facility.Results OH was present in 17 patients (26.6%). The presence of OH was associated with a higher supine systolic blood pressure. The increase in heart rate in the standing position was also reduced in subjects with OH compared with those without. The presence of OH was associated with faster time in the timed up-andgo test compared with those without OH. During the follow-up period, 22 patients (34.4%) had a poor prognosis, of which 8 (36.4%) had OH, which tended to be higher than those with a favorable prognosis. The event-free survival rate appeared to be lower in subjects with OH than in those without. Conclusion OH is relatively common in frail elderly patients with dementia, and it also appears to be associated with a poor prognosis.

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Orthostatic hypotension and mortality risk: a meta-analysis of cohort studies

Abstract: The presence of OH is associated with a significantly increased risk of all-cause mortality, which may partially be mediated by classic risk factors. Further research is needed to determine whether the association between OH and mortality risk is causal.

Cited by 90 publications

References 37 publications

Effects of orthostatic hypotension on cognition in Parkinson disease

Effects of orthostatic hypotension on cognition in Parkinson disease

Clinical implications of delayed orthostatic hypotension

Orthostatic Hypotension Predicts a Poor Prognosis in Elderly People with Dementia

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