Orthostatic hypotension does not increase cardiovascular risk in the elderly at a population level.
BACKGROUND
The general belief that orthostatic hypotension (OH) predisposes to cardiovascular events is based on sparse and contradictory data, rarely derived from population studies.


METHODS
A total of 1,016 men and women aged ≥65 years was studied in a 12-year epidemiological population-based study. Cardiovascular events were detected in subjects with and without OH (blood pressure (BP) decrease ≥20mm Hg for systolic or ≥10mm Hg for diastolic), and Cox analysis was performed including OH as an independent variable.


RESULTS
In univariate analysis, coronary (20.2% vs. 13.1%, P = 0.05), cerebrovascular (13.1% vs. 8.4%, P = 0.05), and heart failure (HF) events (20.2% vs. 13.8%, P = 0.03) were apparently more incidental in subjects with OH than in those without OH. Nevertheless, after adjusting for age, gender, and systolic BP as confounders, OH did not act as a cardiovascular predictor (relative risk for cerebrovascular events 1.33, 95% confidence interval (CI), 0.78-2.2, for coronary events 1.25, CI 0.82-1.88, for HF 1.07, CI 0.71-1.62, for arrhythmias 0.82, CI 0.40-1.37, and for syncope 0.58, CI 0.13-2.71).


CONCLUSIONS
Although OH seems to be a predictor of coronary, cerebrovascular, and HF events, no predictive role was found in models that include biological confounders. Independent of the cause of OH, age and systolic BP, which are positively associated with OH, fully explain the greater incidence of cardiovascular events and the greater cardiovascular risk observed in subjects with OH.
Department of Medicine, University of Padua, Padua, Italy.
Edoardo
E
Casiglia
Valérie
V
Tikhonoff
Sandro
S
Caffi
Giovanni
G
Boschetti
Nunzia
N
Giordano
Federica
F
Guidotti
Federico
F
Segato
Alberto
A
Mazza
Carla
C
Grasselli
Mario
M
Saugo
Giulio
G
Rigoni
Francesco
F
Guglielmi
Bortolo
B
Martini
Paolo
P
Palatini
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
blood pressure; community; epidemiology; hypertension; population; risk.