title: Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies.
abstract: BACKGROUND
  Whether orthostatic hypotension (OH) is a risk factor for cardiovascular morbidity and death is uncertain. Currently available evidence derives from non-homogeneous and partly ambiguous studies.
  
  
  OBJECTIVE
  We aimed at assessing the relationship between OH and death or major adverse cardiac and cerebrovascular events (MACCEs) by integrating results of previous studies.
  
  
  METHODS
  We performed a meta-analysis of prospective observational studies reporting on the association between prevalent OH, mortality, and incident MACCE, published from 1966 through 2013. Mantel-Haenszel pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for all-cause death were assessed as the primary endpoint at the longest follow-up; incident coronary heart disease (CHD), heart failure (HF), and stroke were assessed as secondary endpoints. We also performed post hoc subgroup analyses stratified by age and a meta-regression analysis.
  
  
  RESULTS
  We identified a total of 13 studies, including an overall population of 121 913 patients, with a median follow-up of 6 years. Compared with the absence of OH, the occurrence of OH was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24-1.81), incident CHD (RR 1.41; 95% CI 1.22-1.63), HF (RR 2.25; 95% CI 1.52-3.33), and stroke (RR 1.64; 95% CI 1.13-2.37). When analysed according to age, pooled estimates of RR (95% CI) for all-cause death were 1.78 (1.25-2.52) for patients <65 years old, and 1.26 (0.99-1.62) in the older subgroup.
  
  
  CONCLUSIONS
  Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke.
authors: Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy.
authors: Fabrizio
authors: F
authors: Ricci
authors: Department of Clinical Sciences, Lund University, Clinical Research Center, Skåne University Hospital, 205-02 Malmö, Sweden.
authors: Artur
authors: A
authors: Fedorowski
authors: Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy.
authors: Francesco
authors: F
authors: Radico
authors: Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy.
authors: Mattia
authors: M
authors: Romanello
authors: Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy.
authors: Alfonso
authors: A
authors: Tatasciore
authors: Department of Biomedical Sciences, 'G. D'Annunzio' University, Chieti, Italy.
authors: Marta
authors: M
authors: Di Nicola
authors: Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy.
authors: Marco
authors: M
authors: Zimarino
authors: Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy rdecater@unich.it.
authors: Raffaele
authors: R
authors: De Caterina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality*
keywords: Coronary artery disease; Heart failure; Mortality; Orthostatic hypotension; Stroke