title: Orthostatic Changes in Blood Pressure and Mortality in the Elderly: The Pro.V.A Study.
abstract: BACKGROUND
  An extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people.
  
  
  METHODS
  Two thousand seven hundred and eighty six community-dwelling older participants were followed for 4.4 years. Participants were grouped according to whether they had a drop ≤20 mm Hg in systolic, or ≤10 mm Hg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic BP ≥20 (orthostatic hypertension), or normal changes within 3 minutes of orthostatism.
  
  
  RESULTS
  During follow-up, 640 subjects died, 208 of them for CVD-related reasons. Adjusted Cox's regression analysis revealed that, compared with normal changes, orthostatic hypertension was associated with higher all-cause (HR = 1.23; 95% CI: 1.02-1.39) and CVD-related mortality (HR = 1.41; 95% CI: 1.08-1.74), while orthostatic hypotension was only associated with a higher non-CVD mortality (HR = 1.19; 95% CI: 1.01-1.60). Orthostatic hypertension emerged as a predictor of all-cause mortality for: participants over 75 years old; participants with a BMI below 25 kg/m2; participants with no CVD or disabilities; and those taking less than three medications. Orthostatic hypertension also predicted CVD-related mortality in individuals with no hypertension, heart failure, coronary artery disease, or atrial fibrillation.
  
  
  CONCLUSIONS
  Orthostatic hypertension and hypotension both seem to be relevant risk factors for mortality in the elderly, orthostatic hypertension correlating with all-cause and CVD-related mortality and orthostatic hypotension with non-CVD mortality.
authors.affiliation: Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy; ilmannato@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy;
authors.forename: Marina
authors.initials: M
authors.lastname: De Rui
authors.affiliation: Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy;
authors.forename: Francesco
authors.initials: F
authors.lastname: Bolzetta
authors.affiliation: Department of Medicine-DIMED, Clinica Medica 1, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy;
authors.forename: Sabina
authors.initials: S
authors.lastname: Zambon
authors.affiliation: Division of Health Care Planning and Evaluation of the Regione Veneto, Venice, Italy;
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Corti
authors.affiliation: Internal Medicine Division, Azienda Ospedaliera, Padova, Italy;
authors.forename: Giovanella
authors.initials: G
authors.lastname: Baggio
authors.affiliation: Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy;
authors.forename: Elena Debora
authors.initials: ED
authors.lastname: Toffanello
authors.affiliation: National Research Council, Neuroscience Institute, Padova, Italy;
authors.forename: Stefania
authors.initials: S
authors.lastname: Maggi
authors.affiliation: National Research Council, Neuroscience Institute, Padova, Italy;
authors.forename: Gaetano
authors.initials: G
authors.lastname: Crepaldi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy;
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
authors.affiliation: Geriatrics Section, Department of Medicine-DIMED, University of Padova, Padova, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sergi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D007024:Hypotension, Orthostatic / Q000401:mortality*; D007558:Italy / Q000453:epidemiology; D008297:Male
keywords: blood pressure; cardiovascular disease; elderly; hypertension; mortality.; orthostatic hypertension; orthostatic hypotension