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Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project).

Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O - Eur. Heart J. (2009)

Bottom Line: 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.Orthostatic hypotension can be detected in approximately 6% of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes.Although both impaired systolic and diastolic responses predict adverse events, the diastolic impairment shows stronger association with coronary disease.

View Article: PubMed Central - PubMed

Affiliation: Center for Emergency Medicine, Malmö University Hospital, Entrance 33, Floor 5, 20502 Malmö, Sweden. artur.fedorowski@med.lu.se

ABSTRACT

Aims: 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.

Methods and 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.

Conclusion: 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.

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Related in: MedlinePlus

Orthostatic hypotension (OH) and stroke. One Minus Stroke Event–Free Survival Function adjusted for age, gender, BMI, hypertension, diabetes, total cholesterol, and smoking.
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EHP329F3: Orthostatic hypotension (OH) and stroke. One Minus Stroke Event–Free Survival Function adjusted for age, gender, BMI, hypertension, diabetes, total cholesterol, and smoking.

Mentions: During the follow-up period 6904 individuals (20.7%) died, 3849 (11.5%) suffered from CE and 2134 (6.4%) were diagnosed with incident stroke (86.4% ischaemic, 12.6% haemorrhagic, 1.0% unspecified). Orthostatic hypotension positive individuals demonstrated higher all-cause mortality risk, both in crude [hazard ratio (HR): 1.66, 95% CI 1.53–1.81, P < 0.001] and in adjusted model (HR: 1.19, 95% CI 1.09–1.30, P < 0.001), higher CE risk in crude (HR: 1.58, 95% CI 1.41–1.77, P < 0.001) and adjusted model (HR: 1.18, 95% CI 1.05–1.33, P = 0.007), and higher risk of composite endpoint in both models (HR: 1.59, 95% CI 1.47–1.71, P < 0.001 and 1.18, 1.09–1.27, P < 0.001). Orthostatic hypotension was also related to higher stroke risk in a crude model (HR: 1.59, 95% CI 1.36–1.85, P < 0.001), but this association was attenuated after adjustment for conventional CVD risk factors (HR: 1.11, 95% CI 0.95–1.30, P = 0.21). Effects of baseline OH status on all-cause mortality, incidence of CE, stroke, and composite endpoint in the MPP cohort are presented as multivariate adjusted Cox regression plots in Figures 1–4.


Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project).

Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O - Eur. Heart J. (2009)

Orthostatic hypotension (OH) and stroke. One Minus Stroke Event–Free Survival Function adjusted for age, gender, BMI, hypertension, diabetes, total cholesterol, and smoking.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2800919&req=5

EHP329F3: Orthostatic hypotension (OH) and stroke. One Minus Stroke Event–Free Survival Function adjusted for age, gender, BMI, hypertension, diabetes, total cholesterol, and smoking.
Mentions: During the follow-up period 6904 individuals (20.7%) died, 3849 (11.5%) suffered from CE and 2134 (6.4%) were diagnosed with incident stroke (86.4% ischaemic, 12.6% haemorrhagic, 1.0% unspecified). Orthostatic hypotension positive individuals demonstrated higher all-cause mortality risk, both in crude [hazard ratio (HR): 1.66, 95% CI 1.53–1.81, P < 0.001] and in adjusted model (HR: 1.19, 95% CI 1.09–1.30, P < 0.001), higher CE risk in crude (HR: 1.58, 95% CI 1.41–1.77, P < 0.001) and adjusted model (HR: 1.18, 95% CI 1.05–1.33, P = 0.007), and higher risk of composite endpoint in both models (HR: 1.59, 95% CI 1.47–1.71, P < 0.001 and 1.18, 1.09–1.27, P < 0.001). Orthostatic hypotension was also related to higher stroke risk in a crude model (HR: 1.59, 95% CI 1.36–1.85, P < 0.001), but this association was attenuated after adjustment for conventional CVD risk factors (HR: 1.11, 95% CI 0.95–1.30, P = 0.21). Effects of baseline OH status on all-cause mortality, incidence of CE, stroke, and composite endpoint in the MPP cohort are presented as multivariate adjusted Cox regression plots in Figures 1–4.

Bottom Line: 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.Orthostatic hypotension can be detected in approximately 6% of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes.Although both impaired systolic and diastolic responses predict adverse events, the diastolic impairment shows stronger association with coronary disease.

View Article: PubMed Central - PubMed

Affiliation: Center for Emergency Medicine, Malmö University Hospital, Entrance 33, Floor 5, 20502 Malmö, Sweden. artur.fedorowski@med.lu.se

ABSTRACT

Aims: 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.

Methods and 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.

Conclusion: 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.

Show MeSH
Related in: MedlinePlus