Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study.
OBJECTIVE
To determine the prognostic role of orthostatic hypotension for cardiovascular disease (CVD) and all-cause mortality in elderly people.


METHODS
Prospective study.


METHODS
Community based.


METHODS
Five thousand sixty-four subjects from the Rotterdam study aged 55 and older.


METHODS
Orthostatic hypotension was measured using a Dinamap automatic blood pressure recorder. Orthostatic hypotension is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to standing position at any of three measurements taken 1, 2, and 3 minutes after standing.


RESULTS
At baseline, 901 subjects had orthostatic hypotension. During follow-up, 668 subjects had coronary heart disease (CHD) (mean follow-up 6.0 +/- 3.5 years), and 1,835 subjects died (mean follow-up period 7.8 +/- 3.8 years). Orthostatic hypotension increased the risk of CHD (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.08-1.57) and all-cause mortality (HR=1.22, 95% CI=1.09-1.36), in models adjusted for age and sex. The risk was slightly lower after additional adjustment for cardiovascular risk factors. In analyses stratified for age, the HRs for all-cause mortality were 1.80 (95% CI 1.25-2.60), 1.13 (0.89-1.42), and 1.27 (95% CI=1.11-1.44), in the first, second, and third tertile of age, respectively.


CONCLUSIONS
Orthostatic hypotension increases the risk of CHD and all-cause mortality in elderly people. The risk of CVD and mortality is strongest in younger and very old subjects.
Verwoert
Germaine C
GC
Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.
Mattace-Raso
Francesco U S
FU
Hofman
Albert
A
Heeringa
Jan
J
Stricker
Bruno H C
BH
Breteler
Monique M B
MM
Witteman
Jacqueline C M
JC
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D003327:Coronary Disease / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology