title: Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project).
abstract: 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.
authors.affiliation: Center for Emergency Medicine, Malmö University Hospital, Entrance 33, Floor 5, 20502 Malmö, Sweden. artur.fedorowski@med.lu.se
authors.forename: Artur
authors.initials: A
authors.lastname: Fedorowski
authors.forename: Lars
authors.initials: L
authors.lastname: Stavenow
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Göran
authors.initials: G
authors.lastname: Berglund
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
mesh_terms: 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
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