Orthostatic Hypotension Predicts All-cause Mortality and Coronary Events - New

[JT1024]

Orthostatic Hypotension Predicts All-cause Mortality and Coronary Events in Middle-aged Individuals (The Malm Preventive Project)
Artur Fedorowski; Lars Stavenow; Bo Hedblad; Gran Berglund; Peter M. Nilsson; Olle Melander
Posted: 03/19/2010; European Heart Journal. 2010;31(1):12-14. 2010 Oxford University Press

Abstract and Introduction

Abstract

Aims Orthostatic 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 results Prospective data of the Swedish 'Malm 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 1.31.9, P < 0.0001 and 1.6, 95% CI 1.22.1, P = 0.001] and diastolic BP fall ≥15 mmHg (HR: 1.4, 95% CI 1.11.9, P = 0.024 and 1.7, 95% CI 1.12.5, P = 0.01). In addition, impaired diastolic BP response had relatively greater impact (per mmHg) on CE incidence than systolic reaction.
Conclusion Orthostatic 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.

Introduction

Orthostatic blood pressure (BP) control involves complex compensatory mechanisms allowing the human body to stand upright.[1] As the postural homeostasis is principally mediated by autonomic nervous system, its impairment may lead to BP fall after standing. The phenomenon, denominated as orthostatic hypotension (OH), is often associated with debilitating symptoms: fatigue, dizziness, and fainting.[24] Orthostatic hypotension has been defined by the international consensus as a decrease in systolic BP ≥ 20 mmHg and/or decrease in diastolic BP ≥ 10 mmHg within 3 min of standing.[5,6] In addition, some authors have proposed standing systolic BP< 90 mmHg as an alternative criterion.[7]
Clinicians are usually interested in diagnosing OH as it can cause fall-related injuries,[8] substantially limit patients' quality of life,[9] and finally, impede relevant treatment of concomitant diseases as hypertension or heart failure.[10,11] In parallel, relatively little is known about prognostic aspects of OH. Increased mortality and incidence of cardiovascular disease (CVD) related to prevalent OH has been reported in different high-risk groups[1214] with dominantly symptomatic patients. However, the number of studies regarding the prognostic value of younger and mainly asymptomatic individuals without significant burden of co-morbidities is limited. Prospective data from the Atherosclerosis Risk in Communities (ARIC) study suggest that OH may confer higher risk of all-cause mortality and cardiovascular events.[1517]

Consequently, the aim of our study was to explore prevalence, determinants, and major consequences [total mortality, coronary event (CE), and stroke] of impaired postural haemodynamic response in a Swedish urban middle-aged cohort of the Malm Preventive Project (MPP).

The full text is available in Medscape. I have it in Word but can't upload because it is too large a file.

 

[_Kim_]

Here is an open source full text version of the article:

 

[rebecca1995]

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.

:Retro mad:

This is why we should be living it up while we can! Now, if I could just get down these bloody stairs-- :Retro wink:

 

[kerrilyn]

ACK! That's not good. I only recently realized I have an issue with my diastolic pressure fluctuating when I stand (systolic doesn't really change) and I'm under 42. I had read systolic seemed to be linked more with cardiac issues, but this bursts my bubble!

 

[Sasha]

At first I read this and thought, "oh c*&p!" but then read this:

"[...] mortality risk was more than two times higher in OH positive individuals who were younger than 42 years"

Mortality risk for anybody under 42 is very low so even doubling it (or are they trebling it?), it will still be very low, particularly among those who have already survived to, say, 30 yrs.

"... and conversely, incidence of CE in the same age group showed no significant association with the baseline OH. In parallel, impact of OH on all-cause mortality and CE in the two remaining age groups (42–48 years and over 48 years) was substantially the same as for the whole cohort..."

so you're alright anyway (or as alright as those without OH) after 42.

It's my bedtime so I'm dopey and I've just scanned this rather sloppily but from my superficial look, I don't think we should be scared, whatever our age. It looks like one of those findings that's interesting at a population level, not at an individual level.