Orthostatic Hypotension and Risk of Cardiovascular Disease in Elderly People: The Rotterdam Study

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 56; no. 10; pp. 1816 - 1820
• Main Authors: Verwoert, Germaine C., Mattace-Raso, Francesco U. S., Hofman, Albert, Heeringa, Jan, Stricker, Bruno H. C., Breteler, Monique M. B., Witteman, Jacqueline C. M.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-10-2008; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; all-cause mortality; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - etiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary Disease - etiology; Epidemiology; Female; General aspects; Health risk assessment; Heart Failure - etiology; Humans; Hypotension, Orthostatic - complications; Male; Medical sciences; Middle Aged; Mortality; Netherlands - epidemiology; Older people; orthostatic hypotension; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Stroke - etiology; Netherlands; Europe; Netherlands, Rotterdam; Human; orthostatic hypotension; Nervous system diseases; Mortality; Cardiovascular disease; Epidemiology; Postural hypotension; Gerontology; Arterial hypotension; Diseases of the autonomic nervous system; Cause; Risk factor; all-cause mortality; Elderly; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2008.01946.x

OBJECTIVES: To determine the prognostic role of orthostatic hypotension for cardiovascular disease (CVD) and all‐cause mortality in elderly people.
DESIGN: Prospective study.
SETTING: Community based.
PARTICIPANTS: Five thousand sixty‐four subjects from the Rotterdam study aged 55 and older.
MEASUREMENTS: Orthostatic hypotension was measured using a Dinamap automatic blood pressure recorder. Orthostatic hypotension is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to standing position at any of three measurements taken 1, 2, and 3 minutes after standing.
RESULTS: At baseline, 901 subjects had orthostatic hypotension. During follow‐up, 668 subjects had coronary heart disease (CHD) (mean follow‐up 6.0 ± 3.5 years), and 1,835 subjects died (mean follow‐up period 7.8 ± 3.8 years). Orthostatic hypotension increased the risk of CHD (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.08–1.57) and all‐cause mortality (HR=1.22, 95% CI=1.09–1.36), in models adjusted for age and sex. The risk was slightly lower after additional adjustment for cardiovascular risk factors. In analyses stratified for age, the HRs for all‐cause mortality were 1.80 (95% CI 1.25–2.60), 1.13 (0.89–1.42), and 1.27 (95% CI=1.11–1.44), in the first, second, and third tertile of age, respectively.
CONCLUSION: Orthostatic hypotension increases the risk of CHD and all‐cause mortality in elderly people. The risk of CVD and mortality is strongest in younger and very old subjects.