Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Abstract

BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial.Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49).Conclusions OH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.

Orthostatic hypotension and the risk of atrial fibrillation and other cardiovascular diseases: An updated meta‐analysis of prospective cohort studies

“…Eight studies reported data about the relationship between OH and heart failure . The pooled result demonstrated a positive relationship between OH and HF (summary HR 1.34, 95% CI 1.17‐1.52, P < 0.001), with moderate heterogeneity ( I 2 = 48.7%).…”

“…In total, 1462 articles were retrieved from the literature, of which four articles had the same population. We chose the article written by Juraschek et al for its long follow‐up. Finally, 15 met the inclusion criteria and were included in the meta‐analysis .…”

“…We chose the article written by Juraschek et al for its long follow‐up. Finally, 15 met the inclusion criteria and were included in the meta‐analysis . The majority of studies were performed in Europe, five were conducted in North America, and three were in Asia .…”

“…Finally, 15 met the inclusion criteria and were included in the meta‐analysis . The majority of studies were performed in Europe, five were conducted in North America, and three were in Asia . Most of the cohorts included the general population, and one included hypertensive patients .…”

“…The majority of studies were performed in Europe, five were conducted in North America, and three were in Asia . Most of the cohorts included the general population, and one included hypertensive patients . The other one included patients with both hypertension and diabetes mellitus .…”