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Orthostatic hypotension may raise risk for death, poor CV outcomes
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Orthostatic hypotension is associated with a significantly increased risk for death, incident CHD, HF and stroke, according to the results of a meta-analysis.
Researchers analyzed 13 studies of 121,913 patients with a median follow-up of 6 years, published from 1966 to 2013, to assess the relationship between orthostatic hypotension and death or major adverse cardiac and cerebrovascular events.
According to the study background, a current consensus statement defines orthostatic hypotension as a decrease of at least 20 mm Hg in systolic BP and/or a decrease of at least 10 mm Hg in diastolic BP when someone stands up or performs a head-up tilt test of at least 60°. In those with supine systolic BP greater than 160 mm Hg, orthostatic hypotension is defined as a decrease in systolic BP of at least 30 mm Hg under those conditions.
Fabrizio Ricci, MD, from the institute of cardiology at G. D’Annunzio University, Chieti, Italy, and colleagues reported data that indicate the occurrence of orthostatic hypotension was associated with increased risk for all-cause death (RR = 1.5; 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 Ricci and colleagues analyzed the results according to age, the magnitude of risk for all-cause death was higher in those aged younger than 65 years (RR = 1.78; 95% CI, 1.25-2.52) compared with those aged 65 years or older (RR = 1.26; 95% CI, 0.99-1.62).
“The most likely explanation for this finding is that the presence of [orthostatic hypotension] in younger individuals is a sign of more severe disease, probably of a neurodegenerative etiology, and that in older individuals prevalent comorbidities contribute to weaken the magnitude of effect,” Ricci and colleagues wrote. “Moreover, the exposure time is longer when a disease starts at a younger age.”
In a related editorial, Peter A. Brady, MB, ChB, MD, from the division of cardiovascular diseases at Mayo Clinic, acknowledged several limitations of the meta-analysis, including use of summary instead of raw data; the inability to distinguish CV mortality from non-CV mortality; wide variations in the study populations; and missing trend data and data on the severity and chronicity of the disease.
However, the study “brings new life to an often forgotten clinical sign” and “justifies the routine clinical assessment of [orthostatic hypotension] in any individual undergoing [CV] evaluation since it is easy to measure, requires minimal equipment and expense, yet may provide incremental prognostic value,” Brady wrote. “The question as to whether [orthostatic hypotension] could have a more direct detrimental impact, and though what mechanism, is important but unanswered, and deserves further study.” – by Erik Swain
Disclosure: The researchers and Brady report no relevant financial disclosures.
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