Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project)

Abstract

AimsOrthostatic hypotension (OH) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups, but determinants and consequences of OH in the general population are poorly studied.Methods and resultsProspective data of the Swedish ‘Malmö Preventive Project’ (n = 33 346, 67.3% men, mean age 45.7 ± 7.4 years, mean follow-up 22.7 ± 6.0 years) were analysed. Orthostatic hypotension was found in 6.2% of study participants and was associated with age, female gender, hypertension, antihypertensive treatment, increased heart rate, diabetes, low BMI, and current smoking. In Cox regression analysis, individuals with OH had significantly increased all-cause mortality (in particular those aged less than 42 years) and coronary event (CE) risk. Mortality and CE risk were distinctly higher in those with systolic blood pressure (BP) fall ≥30 mmHg [hazard ratio (HR): 1.6, 95% CI 1.3–1.9, P < 0.0001 and 1.6, 95% CI 1.2–2.1, P = 0.001] and diastolic BP fall ≥15 mmHg (HR: 1.4, 95% CI 1.1–1.9, P = 0.024 and 1.7, 95% CI 1.1–2.5, P = 0.01). In addition, impaired diastolic BP response had relatively greater impact (per mmHg) on CE incidence than systolic reaction.ConclusionOrthostatic hypotension can be detected in ∼6% of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes. Presence of OH increases mortality and CE risk, independently of traditional risk factors. Although both impaired systolic and diastolic responses predict adverse events, the diastolic impairment shows stronger association with coronary disease.

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

“…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.…”

“…Similarly, a recent secondary study of ACCORD (Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial), a trial of blood pressure (BP) reduction in a population with diabetes mellitus, found that although OH was associated with death and heart failure (HF), it was not associated with atherosclerotic events 11. In contrast, many studies have shown that OH is associated with CVD events12, 13, 14, 15, 16, 17 and CVD mortality 14, 18…”

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

“…OH is also associated with adverse cardiovascular health outcomes in middle-age and older adults, including elevated risk for all-cause and cardiovascular mortality and cardiovascular disease (Rose et al, 2006,Verwoert et al, 2008,Masaki et al, 1998, myocardial infarction, transient ischemic attack (Fedorowski et al, 2010) and arterial stiffness (Mattace-Raso et al, 2006). It has been identified as a risk factor for ischemic stroke (Eigenbrodt et al, 2000).…”

Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

“…However, several pathological entities may be associated with autonomic disorders and dysregulation of BP homeostasis leading to orthostatic hypotension and syncope as most obvious adverse events Freeman 2008;Medow et al, 2008). Orthostatic hypotension has been shown to be associated with an increased risk of cardiovascular morbidity and all-cause mortality in the general population (Fedorowski et al, 2010) and in diabetic patients (Maser et al, 2003). Other orthostatic syndromes are also quite frequent such as postural tachycardia and syncope, and appear to be different from classical orthostatic hypotension (Raj, 2010).…”