Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project).
OBJECTIVE
Orthostatic hypotension (OH) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups, but determinants and consequences of OH in the general population are poorly studied.


RESULTS
Prospective data of the Swedish 'Malmö Preventive Project' (n = 33 346, 67.3% men, mean age 45.7 +/- 7.4 years, mean follow-up 22.7 +/- 6.0 years) were analysed. Orthostatic hypotension was found in 6.2% of study participants and was associated with age, female gender, hypertension, antihypertensive treatment, increased heart rate, diabetes, low BMI, and current smoking. In Cox regression analysis, individuals with OH had significantly increased all-cause mortality (in particular those aged less than 42 years) and coronary event (CE) risk. Mortality and CE risk were distinctly higher in those with systolic blood pressure (BP) fall >or=30 mmHg [hazard ratio (HR): 1.6, 95% CI 1.3-1.9, P < 0.0001 and 1.6, 95% CI 1.2-2.1, P = 0.001] and diastolic BP fall >or=15 mmHg (HR: 1.4, 95% CI 1.1-1.9, P = 0.024 and 1.7, 95% CI 1.1-2.5, P = 0.01). In addition, impaired diastolic BP response had relatively greater impact (per mmHg) on CE incidence than systolic reaction.


CONCLUSIONS
Orthostatic hypotension can be detected in approximately 6% of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes. Presence of OH increases mortality and CE risk, independently of traditional risk factors. Although both impaired systolic and diastolic responses predict adverse events, the diastolic impairment shows stronger association with coronary disease.
Fedorowski
Artur
A
Center for Emergency Medicine, Malmö University Hospital, Entrance 33, Floor 5, 20502 Malmö, Sweden. artur.fedorowski@med.lu.se
Stavenow
Lars
L
Hedblad
Bo
B
Berglund
Göran
G
Nilsson
Peter M
PM
Melander
Olle
O
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000503:physiopathology; D013548:Sweden / Q000453:epidemiology; D014504:Urban Health
J Chronic Dis. 1985;38(4):319-26
3998049
Am Heart J. 2006 Jan;151(1):76-83
16368295
Stroke. 2007 Oct;38(10):2681-5
17761929
Gerontology. 2009;55(2):138-44
18583904
J Clin Pharmacol. 1994 May;34(5):375-86
8089249
Stroke. 2001 May;32(5):1098-103
11340216
Neurology. 1996 May;46(5):1470
8628505
Lancet Neurol. 2008 May;7(5):451-8
18420158
BMJ. 2008 Jan 19;336(7636):130-3
18089892
Cardiovasc Hematol Disord Drug Targets. 2007 Mar;7(1):63-70
17346129
Arch Intern Med. 1995 May 8;155(9):930-5
7726701
Prev Med. 1983 May;12(3):397-402
6878198
J Am Geriatr Soc. 1991 Jun;39(6):562-6
2037745
J Intern Med. 2000 Jan;247(1):19-29
10672127
Med Biol Eng Comput. 2008 May;46(5):411-9
18365262
Stroke. 2000 Oct;31(10):2307-13
11022055
Am J Med. 2007 Oct;120(10):841-7
17904451
Am J Hypertens. 2000 Jun;13(6 Pt 1):571-8
10912737
Eur J Neurol. 2006 Sep;13(9):930-6
16930356
JAMA. 1997 Apr 23-30;277(16):1299-304
9109468
Am J Geriatr Cardiol. 2005 Sep-Oct;14(5):221-3
16247279
J Clin Epidemiol. 2001 May;54(5):488-94
11337212
J Hypertens. 2007 Jun;25(6):1105-87
17563527
Drugs Aging. 2005;22(1):55-68
15663349
J Intern Med. 1996 Jun;239(6):489-97
8656142
J Hum Hypertens. 2004 Oct;18(10):717-23
15116144
Int J Geriatr Psychiatry. 2006 Aug;21(8):778-83
16906622
J Gerontol. 1991 Sep;46(5):M159-63
1890281
Annu Rev Med. 1999;50:317-36
10073281
Arch Intern Med. 1999 Jun 28;159(12):1350-6
10386511
J Intern Med. 2004 Apr;255(4):486-93
15049883
J Hum Hypertens. 2009 Jan;23(1):33-9
18650837
Stroke. 1992 Mar;23(3):357-61
1542896
Med J Aust. 2007 Sep 3;187(5):299-304
17767437
Circulation. 2006 Aug 15;114(7):630-6
16894039