Orthostatic hypertension and major adverse events: a systematic review and meta-analysis

Abstract

Introduction The role of orthostatic hypertension (OHT) in cardiovascular disease (CVD) and mortality is unclear. We aimed to determine if this association exists through a systematic review and meta-analysis. Methods Study inclusion criteria included: (i) any observational/interventional studies of participants aged ≥18 years (ii) which assessed the relationship between OHT and (iii) at least one outcome measure – all-cause mortality (primary outcome), coronary heart disease, heart failure, stroke/cerebrovascular disease, or neurocognitive decline. MEDLINE, EMBASE, Cochrane, clinicaltrials.gov and PubMed were independently searched by two reviewers (inception-19th April 2022). Critical appraisals were conducted using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed using a generic inverse variance method, and narrative synthesis, or pooled results were presented as an odds or hazards ratio (HR/OR), with 95% confidence interval. Results Twenty studies (n = 61669; 47.3% women) were eligible, of which thirteen were included in the meta-analysis (n = 55456; 47.3% women). Median (IQR) follow-up for prospective studies was 7.85 (4.12, 10.83) years. Eleven studies were of good quality, eight fair and one poor. Relative to orthostatic normotension (ONT), systolic OHT (SOHT) was associated with a significant 21% greater risk of all-cause mortality (HR:1.21,1.05-1.40), 39% increased risk of CVD mortality based on 2 studies (HR:1.39, 1.05-1.84) and near doubled odds of stroke/cerebrovascular disease (OR:1.94, 1.52-2.48). Lack of association with other outcomes may be due to weak evidence or low statistical power. Conclusions Patients with SOHT may have higher mortality risk relative to those with ONT and increased odds of stroke/cerebrovascular disease. Whether interventions can reduce OHT and improve outcomes should be explored.

Association Between Orthostatic Hypertension and Frailty Among Older Patients With Hypertension

“…Finally, a recent meta-analysis confirmed that orthostatic hypertension is associated with increased mortality. 22 Frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from an aging-associated decline in reserve function across multiple physiological systems. The Fried criteria are the most commonly used measurement of performance (walking speed, grip strength) and are scored based on relative values in a population.…”

Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH)

“…On the other hand, orthostatic hypertension (OHTN) role in cardiovascular disease is notable in elderly. Pasdar et al showed systolic OHT was associated with increased risk of mortality, cognitive impairment, cardiovascular and brain comorbidities [ 34 , 35 ].…”

Raising awareness for cardiovascular autonomic dysfunction: the 2023 European Society of Hypertension guidelines revisited

“…The authors suggest that there is no generally accepted definition of orthostatic hypertension, but a resent consensus document that was published in this Journal made the distinction between an exaggerated pressor response, defined as a sustained systolic blood pressure increase of at least 20 mmHg when changing from the supine to the standing position, and orthostatic hypertension, when an exaggerated pressor response is associated with upright systolic blood pressure of at least 140 mmHg [4,5]. Population studies find similar prevalence of both extremes of blood pressure response to standing, orthostatic hypotension, and orthostatic hypertension, and epidemiological studies indicate that both conditions herald increased cardiovascular risk [6][7][8]. Even less pronounced changes in blood pressure with standing not reaching these diagnostic cutoff levels may be associated with poor outcomes.…”