Orthostatic Hypotension as a Risk Factor for Stroke

Abstract

Background and Purpose-The association between orthostatic hypotension (OH) and stroke has rarely been investigated in longitudinal studies. The purpose of the present study was to determine whether OH predicts ischemic stroke in a middle-aged, biethnic population after adjustment for known stroke risk factors. Diastolic, systolic, and consensus OH were evaluated for baseline associations and for the ability to predict stroke. Methods-In 11 707 persons from the Atherosclerosis Risk in Communities (ARIC) cohort who were free of stroke and overt heart disease at baseline, Cox proportional hazards analyses modeled the association between OH at baseline and incident ischemic stroke over 7.9 years of follow-up. OH was defined as a systolic blood pressure drop Ն20 mm Hg (systolic OH), a diastolic blood pressure drop Ն10 mm Hg (diastolic OH), or a drop in either (consensus OH) when a person changed from a supine to standing position. Results-OH was predictive of ischemic stroke, even after adjustment for numerous stroke risk factors (consensus OH:hazard ratio, 2.0; 95% CI, 1.2 to 3.2). While the baseline characteristics associated with OH varied depending on the type of OH, all types of OH had a similar risk of stroke. Conclusions-OH is an easily obtained measurement that may help to identify middle-aged persons at risk for stroke.

Prevalence and correlates of orthostatic hypotension in middle-aged men and women in Korea: the Korean Health and Genome Study

“…[1][2][3]5,6,10,11,13,14 In the current report, lower BMI was positively related to an excess in the odds of OH. Although findings were adjusted for age, hypertension, diabetes, cigarette smoking, total cholesterol, HDL cholesterol, and triglycerides, other unknown comorbidities in leaner individuals are likely to have contributed to this finding.…”

“…In the Atherosclerosis Risk in Communities (ARIC) study, which is a survey of Caucasian and Black men and women aged 45-64 years, prevalence was 5%. 1,2 This difference in the prevalence of OH between studies is largely due to methodological differences. As noted in our methods, we measured supine BP three times after at least 5-min of rest and a single standing BP at 0 and 2 min of standing.…”

“…In the ARIC study, however, supine BPs were taken for 2 min with an automated oscillometric device after a 20 min supine rest, and in the same manner, standing BPs were taken after subject's feet touched the ground. 1,2 As discussed by the authors of the ARIC study, the use of average standing BPs, rather than a single standing BP, seemed to avoid missing OH if a single standing BP is used since measuring standing pressure at 1 vs 3 min may identify different individuals. 2 Therefore, the prevalence of OH in the ARIC study is higher than the prevalence of OH at 2 min of standing in the current study.…”

“…[1][2][3][4][5][6][7] Depending on how OH is measured, however, prevalence can range markedly from 5 to 30%, [3][4][5][6][7][8][9][10][11][12][13][14][15] making it difficult to describe cross-cultural variation or to identify effects that may be associated with OH. 1,2,4,14,15 Low rates of coronary heart disease in Asia vs the US and Western Europe suggest that the prevalence and correlates of OH may also be different through associations with risk factors that are culturally unique. Unfortunately, few studies of OH have been conducted in Asia, and none have occurred in a general population setting in Korea.…”

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

“…Furthermore, sudden recurrent decreases in BP with standing could contribute to end‐organ damage. Several studies have shown OH to be associated with diseases of end‐organ hypoperfusion, such as stroke40 and peripheral artery disease 13. In our study, the association between OH and detectable hs‐cTnT may indicate microischemia from recurrent hypoperfusion of coronary vessels 29.…”