Orthostatic Hypotension Predicts Mortality in Elderly Men

Abstract

Background-Population-based data are unavailable concerning the predictive value of orthostatic hypotension on mortality in ambulatory elderly patients, particularly minority groups. Methods and Results-With the use of data from the Honolulu Heart Program's fourth examination (1991 to 1993), orthostatic hypotension was assessed in relation to subsequent 4-year all-cause mortality among a cohort of 3522 Japanese American men 71 to 93 years old. Blood pressure was measured in the supine position and after 3 minutes of standing, with the use of standardized methods. Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) of Ն20 mm Hg or in diastolic blood pressure of Ն10 mm Hg. Overall prevalence of orthostatic hypotension was 6.9% and increased with age. There was a total of 473 deaths in the cohort over 4 years; of those who died, 52 had orthostatic hypotension. Four-year age-adjusted mortality rates in those with and without orthostatic hypotension were 56.6 and 38.6 per 1000 person-years, respectively. With the use of Cox proportional hazards models, after adjustment for age, smoking, diabetes mellitus, body mass index, physical activity, seated systolic blood pressure, antihypertensive medications, hematocrit, alcohol intake, and prevalent stroke, coronary heart disease and cancer, orthostatic hypotension was a significant independent predictor of 4-year all-cause mortality (relative risk 1.64, 95% CI 1.19 to 2.26). There was a significant linear association between change in systolic blood pressure from supine position to standing and 4-year mortality rates (test for linear trend, PϽ0.001), suggesting a dose-response relation. Conclusions-Orthostatic hypotension is relatively uncommon, may be a marker for physical frailty, and is a significant independent predictor of 4-year all-cause mortality in this cohort of elderly ambulatory men. (Circulation. 1998;98:2290-2295.)

Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

“…The change in BP on active standing test is recommended in the Japanese Society of Hypertension Guideline, 9 although previous studies have used the definition of orthostatic BP change based on the change in BP from the supine to the standing position. [6][7][8] In summary, the present study revealed that orthostatic BP changes detected by HBPM had better reproducibility than the corresponding BP changes detected by clinic BP measurements, and a closer correlation with UAR was obtained with HBPM. In the group of patients with OHT, treatment with doxazosin suppressed the orthostatic BP increase, which in turn might have reduced the UAR.…”

“…[3][4][5] In most previous studies, post-ural BP changes have been evaluated by clinical BP or by BP readings taken during head up-tilt test, although the reproducibility of these BP measurements is still matter of controversy. 3,[5][6][7][8] Home BP monitoring (HBPM) has been recently recommended as a convenient and reproducible method of BP measurement in hypertension management, with a better prognostic value than clinical BP measurements. [9][10][11] However, no data are available on the reproducibility of orthostatic BP changes when assessed by means of HBPM, which we previously showed to be more closely associated with increased albuminuria than when patients were assessed by clinical BP.…”

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.…”

“…Most studies of OH have focused on the elderly, [3][4][5][6][8][9][10][11][12][13][14][15] where reported prevalence ranges from 5 to 30%. Unfortunately, the use of different methods to define OH makes it difficult to compare study findings.…”

“…[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.…”