Orthostatic hypotension and the risk of atrial fibrillation and other cardiovascular diseases: An updated meta‐analysis of prospective cohort studies

Abstract

The relationships between orthostatic hypotension (OH) and some kinds of cardiovascular disease are inconsistent among studies. This updated meta‐analysis was conducted in hopes of producing progress on this topic. A systematic database search was performed in electronic databases, including the Chinese Biomedical Database (CBM), PubMed, Web of Science, and the Cochrane Library. Summary hazard ratio (HR) estimates with 95% confidence intervals (CIs) were calculated by a random‐effects model. Statistical heterogeneity was assessed with Cochran's Q test and the I2 statistic. From 1462 potentially eligible records, 15 studies met the inclusion criteria. Subjects with OH had a high risk of heart failure (HF) and atrial fibrillation (AF) (pooled HR 1.34, 95% CI 1.17‐1.52, P < 0.001 and pooled HR 1.51, 95% CI 1.28‐1.79, P < 0.001, respectively). This meta‐analysis also showed significant associations between OH and the risks of developing coronary heart disease (CHD) (pooled HR 1.44, 95% CI 1.18‐1.75, P < 0.001) and myocardial infarction (MI) (pooled HR 1.52, 95% CI 1.12‐2.06, P = 0.008). Our study suggests that OH is positively associated with high risks of HF and AF. Moreover, it may be related to high risks of CHD and MI.

Postural hypotension

“…Postural hypotension worsens physical function and impairs balance and ability to perform activities of daily living 18. Large meta-analyses reported increased risk of falls (odds ratio 1.73, 95% confidence interval 1.50 to 1.991), heart failure (hazard ratio 1.34, 95% CI 1.17 to 1.5219), coronary heart disease (hazard ratio 1.44, 1.18 to 1.7519), stroke (hazard ratio 1.64, 1.13 to 2.372), atrial fibrillation (hazard ratio 1.51, 1.28 to 1.7919), and all-cause mortality (relative risk 1.50, 1.24 to 1.812) with postural hypotension. Small studies point to an increased risk of cognitive impairment, dementia, and depression 34.…”

Orthostatic hypotension and cardiovascular events—Closing the link?

“…Notwithstanding the association of OH with several clinical conditions and significant events, the definition of OH as an independent cardiovascular risk factor remains a controversial topic, motivating the systematic review and meta-analysis published by Min et al 10…”

“…Notwithstanding the association of OH with several clinical conditions and significant events, the definition of OH as an independent cardiovascular risk factor remains a controversial topic, motivating the systematic review and meta‐analysis published by Min et al After a thorough literature search, the authors included 15 prospective cohort studies that met the inclusion criteria. Most of these studies included European populations (eight studies), and the remaining were performed either in North America (five studies) or Asia (three studies), representing general population (13 studies), one study with a hypertensive cohort and another one with a mixed cohort with both hypertensive and diabetic participants.…”

“…Being strongly associated with aging 7 and with the current demographic trends showing an increase in the proportion of the population above 65 years of age, the burden of OH is also expected to increase and contribute to a greater risk of falling, disability and reduced quality of life in the elderly. 8,9 Therefore, as a serious public health problem, OH must be comprehensively addressed and efficient management options are needed to reduce its associated hazards.Notwithstanding the association of OH with several clinical conditions and significant events, the definition of OH as an independent cardiovascular risk factor remains a controversial topic, motivating the systematic review and meta-analysis published by Min et al 10 After a thorough literature search, the authors included 15 prospective cohort studies that met the inclusion criteria. Most of these studies included European populations (eight studies), and the remaining were performed either in North America (five studies) or Asia (three studies), representing general population (13 studies), one study with a hypertensive cohort and another one with a mixed cohort with both hypertensive and diabetic participants.…”

Rationale and design of multicenter prospective observational study of types, GRAde, VariabilITY, associations and prognosis of orthostatic responses in Heart Failure (GRAVITY-HF)

“…Недавний анализ данных проспективного наблюдательного исследования ARIC (n=9139, средний возраст 54±5,7 лет, без сердечно-сосудистых заболеваний) показал, что это верно и для пациентов среднего возраста: ОГ была ассоциирована со значимым повышением риска развития ИБС, инфаркта миокарда, инсульта, смерти от ИБС и смерти от любой причины [4]. В метаанализе Ricci F, et al ОГ была ассоциирована со значительным повышением риска развития СН [3], что согласуется с данными другого метаанализа 15 проспективных наблюдательных исследований [5] и анализа исследования ARIC среди пациентов среднего возраста [4]. Кроме того, показано неблагоприятное прогностическое значение уровня систолического артериального давления (САД), измеренного на 3-5 мин ортостаза, как на выживаемость пациентов, так и на риск госпитализации из-за СН, что позволило включить параметр в калькулятор прогнозирования однолетней выживаемости больных с СН с низкой фракцией выброса левого желудочка [6][7].…”