Orthostatic Hypotension Does Not Increase Cardiovascular Risk in the Elderly at a Population Level

Casíglia, Edoardo; Tikhonoff, Valérie; Caffi, Sandro; Boschetti, Giovanni; Giordano, Nunzia; Guidotti, Federica; Segato, Federico; Mazza, Alberto; Grasselli, Carla; Saugo, Mario; Rigoni, Giulio; Guglielmi, Francesco William; Martini, Bortolo; Palatini, Paolo

doi:10.1093/ajh/hpt172

Cited by 28 publications

(20 citation statements)

References 57 publications

(84 reference statements)

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“…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%).…”

Section: Resultsmentioning

confidence: 95%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

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

Min

Shi

Sun

et al. 2019

J of Clinical Hypertension

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The relationships between orthostatic hypotension (OH) and some kinds of cardiovascular disease are inconsistent among studies. This updated meta‐analysis was conducted in hopes of producing progress on this topic. A systematic database search was performed in electronic databases, including the Chinese Biomedical Database (CBM), PubMed, Web of Science, and the Cochrane Library. Summary hazard ratio (HR) estimates with 95% confidence intervals (CIs) were calculated by a random‐effects model. Statistical heterogeneity was assessed with Cochran's Q test and the I2 statistic. From 1462 potentially eligible records, 15 studies met the inclusion criteria. Subjects with OH had a high risk of heart failure (HF) and atrial fibrillation (AF) (pooled HR 1.34, 95% CI 1.17‐1.52, P < 0.001 and pooled HR 1.51, 95% CI 1.28‐1.79, P < 0.001, respectively). This meta‐analysis also showed significant associations between OH and the risks of developing coronary heart disease (CHD) (pooled HR 1.44, 95% CI 1.18‐1.75, P < 0.001) and myocardial infarction (MI) (pooled HR 1.52, 95% CI 1.12‐2.06, P = 0.008). Our study suggests that OH is positively associated with high risks of HF and AF. Moreover, it may be related to high risks of CHD and MI.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Min

Shi

Sun

et al. 2019

J of Clinical Hypertension

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“…[3][4][5][6] Extensive research has also tended (with some exceptions) to support a role for orthostatic hypotension as a risk factor for CVD in the elderly. [7][8][9] On the contrary orthostatic hypertension, has been less thoroughly analyzed. 10 It seems to affect about 10% of older people, but its reported prevalence varies because different criteria have been adopted to define it.…”

Section: Original Articlementioning

confidence: 99%

Treatment of Neurogenic Orthostatic Hypotension

Byun¹,

Kim²

2017

Res Vestib Sci

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Orthostatic blood pressure dysregulation is common among older people owing to the aging process itself as well as to dysautonomia due to comorbidities such as Parkinson's disease, cardiovascular diseases (CVD) or diabetes, and the use of medication (such as antihypertensive agents and benzodiazepines).The most often studied orthostatic blood pressure dysregulation is orthostatic hypotension, which is identified in approximately 20-30% of individuals over 65 years of age 1,2 and is associated with an increase CVD unrelated mortality. [3][4][5][6] Extensive research has also tended (with some exceptions) to support a role for orthostatic hypotension as a risk factor for CVD in the elderly. 7-9 On the contrary orthostatic hypertension, has been less thoroughly analyzed. 10 It seems to affect about 10% of older people, but its reported prevalence varies because different criteria have been adopted to define it. 11 Recent researches point to orthostatic hypertension as an emerging hemodynamic cardiovascular risk factor, particularly in older people with essential hypertension. 10,12 The condition seems to be associated with more severe organ damage and a greater risk of clinical and subclinical CVD events. 11,12 To the best of our knowledge, no published data are available on the association between orthostatic hypertension and mortality.Based on these premises, we hypothesized that not only orthostatic hypotension, but also orthostatic hypertension may be associated to a higher risk of mortality. Orthostatic Changes in Blood Pressure BACKGROUNDAn extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people.

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Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany

et al. 2020

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Aims Whereas syncopal episodes are a frequent complication of cardiovascular disorders, including heart failure (HF), little is known whether syncopes impact the prognosis of patients with HF. We aimed to assess the impact of a history of syncope (HoS) on overall and hospitalization-free survival of these patients. Methods and resultsWe pooled the data of prospective, nationwide, multicentre studies conducted within the framework of the German Competence Network for Heart Failure including 11 335 subjects. Excluding studies with follow-up periods <10 years, we assessed 5318 subjects. We excluded a study focusing on cardiac changes in patients with an HIV infection because of possible confounding factors and 849 patients due to either missing key parameters or missing follow-up data, resulting in 3594 eligible subjects, including 2130 patients with HF [1564 patients with heart failure with reduced ejection fraction (HFrEF), 314 patients with heart failure with mid-range ejection fraction, and 252 patients with heart failure with preserved ejection fraction (HFpEF)] and 1464 subjects without HF considered as controls. HoS was more frequent in the overall cohort of patients with HF compared with controls (P < 0.001)-mainly driven by the HFpEF subgroup (HFpEF vs. controls: 25.0% vs. 12.8%, P < 0.001). Of all the subjects, 14.6% reported a HoS. Patients with HFrEF in our pooled cohort showed more often syncopes than subjects without HF (15.0% vs. 12.8%, P = 0.082). Subjects with HoS showed worse overall survival [42.4% vs. 37.9%, hazard ratio (HR) = 1.21, 99% confidence interval (0.99, 1.46), P = 0.04] and less days alive out of hospital [HR = 1.39, 99% confidence interval (1.18, 1.64), P < 0.001] compared with all subjects without HoS. Patients with HFrEF with HoS died earlier [30.3% vs. 41.6%, HR = 1.40, 99% confidence interval (1.12, 1.74), P < 0.001] and lived fewer days out of hospital than those without HoS. We could not find these changes in mortality and hospital-free survival in the heart failure with mid-range ejection fraction and HFpEF cohorts. HoS represented a clinically high-risk profile within the HFrEF group-combining different risk factors. Further analyses showed that among patients with HFrEF with HoS, known cardiovascular risk factors (e.g. age, male sex, diabetes mellitus, and anaemia) were more prevalent. These constellations of the risk factors explained the effect of HoS in a multivariable Cox regression models. Conclusions In a large cohort of patients with HF, HoS was found to be a clinically and easily accessible predictor of both overall and hospitalization-free survival in patients with HFrEF and should thus routinely be assessed.

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Orthostatic Hypotension Does Not Increase Cardiovascular Risk in the Elderly at a Population Level

Cited by 28 publications

References 57 publications

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

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

Treatment of Neurogenic Orthostatic Hypotension

Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany

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