Orthostatic blood pressure response, carotid intima–media thickness, and plasma fibrinogen in older nondiabetic adults

Fedorowski, Artur; Östling, Gerd; Persson, Margaretha; Struck, Joachim; Engström, Gunnar; Nilsson, Peter M.; Hedblad, Bo; Melander, Olle

doi:10.1097/hjh.0b013e32834fa860

Cited by 34 publications

(23 citation statements)

References 33 publications

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“…However, the important heterogeneity based mainly on the different type of the cardiovascular outcome studied in each review (heart failure, cardiovascular event, MI, syncope) did not allow the performance of a metaanalysis, which could solidify this observation. The increased vascular inflammatory process, the peripheral artery disease, and the higher dyslipidemia found in patients with orthostatic hypotension (without diabetes) compared to those without orthostatic hypotension [43,44] could account for this strong correlation. In one of them [13], a DBP fall greater than 8 mmHg was most significant predictor of myocardial infarcts.…”

Section: Discussionmentioning

confidence: 98%

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

Angelousi

Girerd

Bénétos³

et al. 2014

Journal of Hypertension

144

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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.

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Section: Discussionmentioning

confidence: 98%

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

Angelousi

Girerd

Bénétos³

et al. 2014

Journal of Hypertension

144

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“…Furthermore, increasing studies in both animal models [28] and human patients [29] suggested that activation of baroreflex with an implanted device may be a potential treatment for CHF, reflecting the fact that dysregulation of baroreflex may be an intermediate process for the association between OH and incident CHF. In addition to autonomic dysfunction, some other mechanisms have also been suggested to be involved, such as reduced coronary flow caused by frequent postural BP drop [30], increased early subclinical atherosclerotic burden [31], [32], abnormal nocturnal change in BP [33], and increased longstanding cardiovascular overload [22]. These mechanisms are also needed to be confirmed by future studies.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension and the Risk of Congestive Heart Failure: A Meta-Analysis of Prospective Cohort Studies

Wei

Lin²,

2013

PLoS ONE

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BackgroundOrthostatic hypotension (OH) has been related to the increased risk of future congestive heart failure (CHF) events. However, the overall quantitative estimate of predictive ability of OH for CHF has not been determined. We therefore performed a meta-analysis to investigate the association between OH and incident CHF.MethodsProspective cohort studies relevant to the aim of the study were identified by searching of Medline and Embase databases up to December 25, 2012 without restrictions and by reviewing the reference lists from retrieved articles.ResultsA total of 51270 subjects and 3603 incident CHF cases from 4 prospective cohorts were included in the meta-analysis. Using random effect model, the pooled result indicated that presence of OH at baseline was significantly associated with an increased risk for future CHF outcomes (adjusted hazard ratio: 1.30, 95% confidence interval 1.09–1.55; p = 0.004). Results of stratified analysis suggested that the association between OH and CHF incidence seemed to be significant in middle-age subjects, or the individuals with hypertension and diabetes at baseline, but did not significant in the elderly subjects or those without hypertension or diabetes.ConclusionsOur meta-analysis confirmed that presence of OH is related to a significant increased risk for development of CHF in the future. Studies are needed to explore the potential mechanisms underlying this association. More importantly, screen for OH may be of great clinical significance for the early identification of subjects at higher risk for development of CHF.

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“…In parallel, some authors observed that an orthostatic SBP but not DBP decrease was associated with greater lacunar stroke incidence, whereas occurrence of nonlacunar ischemic stroke, including cardioembolic etiology, was more strongly related to systolic than diastolic orthostatic hypotension [9]. Moreover, both carotid intima-media thickness and fibrinogen, well established indicators of elevated stroke risk [18,19], are increased in orthostatic hypotension [20] as is also arterial stiffness [21]. Moreover, both carotid intima-media thickness and fibrinogen, well established indicators of elevated stroke risk [18,19], are increased in orthostatic hypotension [20] as is also arterial stiffness [21].…”

Section: Orthostatic Hypotension In Treated Hypertensionmentioning

confidence: 99%

“…Thus, decrement of DBP on standing indicates not only an absolute reduction of BP relative to supine position, but also a lack of its compensatory increase. via promotion of atherosclerosis and systemic inflammation [20]) and by inducing structural changes in myocardium, such as left ventricular hypertrophy and dysfunction [16,17,27]. Repeated and pronounced decreases in DBP may lead to periodic myocardial hypoperfusion and exacerbation of the coexisting atherosclerosis.…”

Section: Diastolic Orthostatic Hypotension and Myocardial Infarctionmentioning

confidence: 99%

Systolic and diastolic component of orthostatic hypotension and cardiovascular events in hypertensive patients

Fedorowski

Wahlstrand

Hedner

et al. 2014

Journal of Hypertension

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Orthostatic blood pressure response, carotid intima–media thickness, and plasma fibrinogen in older nondiabetic adults

Abstract: In older nondiabetic adults only orthostatic hypotension seems to independently correlate with increased carotid atherosclerosis and systemic inflammation.

Cited by 34 publications

References 33 publications

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

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

Orthostatic Hypotension and the Risk of Congestive Heart Failure: A Meta-Analysis of Prospective Cohort Studies

Systolic and diastolic component of orthostatic hypotension and cardiovascular events in hypertensive patients

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