Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality

Abstract

Objective: Several studies have suggested that orthostatic hypotension may be an independent predictor of cardiovascular or cerebrovascular risk and all-cause mortality, particularly in a geriatric population. In 1996, a consensus defined orthostatic hypotension as a SBP fall at least 20 mmHg and/or a DBP fall at least 10 mmHg within 3 min of standing.Methods: Pubmed and Cochrane database were searched up to October 2013 in order to identify prospective studies evaluating, in adult populations, the association between orthostatic hypotension as defined by the 1996 consensus and clinical outcome. Meta-regression was performed when sufficient data were available.Results: A total of 28 prospective studies were found eligible for inclusion in this systematic review. Nine prospective studies found an association between orthostatic hypotension and various cardiovascular events such as coronary disease, heart failure, and arrhythmias. No association was found between orthostatic hypotension and the risk for strokes and falls in the majority of the prospective included studies. Insufficient data were available to perform a meta-analysis for strokes and falls. The meta-analysis of seven prospective studies found that orthostatic hypotension is associated with a significant increased risk for overall mortality [pooled hazard ratio in random-effects model ¼ 1.36 (1.13-1.63), P < 0.001)].Conclusion: This meta-analysis provides evidence that orthostatic hypotension is associated with a 36% increase in the risk of overall mortality. A systematic review of the literature suggests that orthostatic hypotension is also associated with a higher risk for cardiovascular events. Insufficient data are available to enable a precise assessment of the association of orthostatic hypotension with strokes and falls.

An Expert Opinion From the European Society of Hypertension–European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects

“…[17][18][19] Por lo tanto, deberían considerarse los riesgos y beneficios (incluida la conservación de la autonomía) del tratamiento antihipertensivo antes de iniciar un tratamiento en la población débil de edad tan avanzada. Esta población es la que tiene mayor riesgo no solo de eventos cardiovasculares relacionados con la hipertensión sino también de eventos relacionados con la hipotensión.…”

“…[17][18][19] Therefore, both the benefits (including preserving autonomy) and the risks of antihypertensive therapy should be considered before starting treatment in the very frail older population. This population is the one at the highest risk of not only hypertension-related cardiovascular events but also hypotension-related events.…”

O2‐09‐03: Orthostatic Hypotension and the Long‐Term Risk of Dementia: A Population‐Based Study

“…For instance, decreased arterial wall compliance with hypertension likely contributes to OH by diminishing baroreceptor sensitivity [36]. Arterial stiffness and OH are both associated with increased burden of cerebral white matter lesions and vascular disease including stroke [9,28,37,38]. As these are established risk factors for dementia, these conditions may act as mediators or indicate shared aetiology between diseases.…”

“…This drop in blood pressure may elicit transient cerebral hypoperfusion, especially in the absence of a compensatory increase in heart rate. OH is associated with an increased risk of cardiovascular events, stroke, and mortality [9]. Moreover, OH is highly prevalent among patients with dementia and mild cognitive impairment, compared to healthy controls [10][11][12][13], but only one study has assessed the longitudinal relation between OH and the risk of dementia in initially healthy participants.…”

Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults

“…1 However, recent research has proposed OH as a potential cardiovascular risk factor, since OH seems to be able to predict cardiovascular events and all-cause mortality. [2][3][4][5] A number of studies have demonstrated a possible role for hypovitaminosis D, defined as lower serum 25-hydroxyvitamin D (25OHD) levels, as a potential risk factor for vascular diseases, including hypertension. The association between 25OHD and hypertension was recently reported in a large meta-analysis, showing that increased 25OHDconcentrations were significantly associated with decreased odds of hypertension.…”