Orthostatic hypotension and the risk of myocardial infarction in the home-dwelling elderly.
OBJECTIVE
We investigated the prognostic significance of orthostatic hypotension on the risk of myocardial infarction (MI) amongst the elderly.


METHODS
Prospective population-based study.


METHODS
Home-dwelling population.


METHODS
Orthostatic testing was performed between 8 a.m. and 2 p.m., irrespective of having had meals, on 792 persons, representing 82% of all home-dwelling persons aged > or =70 years living in five municipalities around the city of Oulu.


METHODS
Occurrence of cases of MI were recorded during mean 3.58 (SD 1.09) years follow-up period, from national mortality statistics and local hospital discharge registers.


RESULTS
Ninety cases of MI, of which 40 were fatal after initial hospitalization, occurred during the follow-up period. Orthostatic diastolic blood pressure (BP) drop 1 min after standing up was associated with subsequent MI, but systolic BP reactions had no predictive value. According to the Cox regression model, the strongest predictor of the occurrence of subsequent MI was found in regard to > or =8 mmHg drop in diastolic BP 1 min after standing up; adjusted for history of MI, diabetes mellitus, chest pain, use of calcium antagonist, beta-blocker, nitrate and diuretic medication, hazard ratio of MI being 2.00 (1.11-3.59).


CONCLUSIONS
Orthostatic testing offers a novel means to assess the risk of MI amongst elderly persons. Diastolic BP drop immediately after standing up identifies elderly subjects at a high risk of subsequent MI.
Luukinen
H
H
Department of Public Health Science and General Practice, University of Oulu, and Unit of General Practice, Oulu University Hospital, Finland. heikki.luukinen@oulu.fi
Koski
K
K
Laippala
P
P
Airaksinen
K E J
KE
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D002637:Chest Pain / Q000150:complications; D048909:Diabetes Complications; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006334:Heart Function Tests / Q000379:methods; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications*; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
D002121:Calcium Channel Blockers; D004232:Diuretics