Orthostatic Hypotension and Cardiovascular Morbidity and Mortality | Journal Scan

Study Questions:

What is the relationship between orthostatic hypotension (OH) and death or major adverse cardiac and cerebrovascular events (MACCEs)?


This was a meta-analysis of prospective observational studies that reported the association between prevalent OH, mortality, and incident MACCE. The primary endpoint was all-cause death; secondary endpoints were incident coronary heart disease (CHD), heart failure (HF), and strokes.


The authors included 13 eligible studies for an analytic sample of 121,913 patients with a median follow-up of 6 years. Compared to those without OH, those with OH had a significantly increased risk of all-cause death (relative risk [RR], 1.50; 95% confidence interval [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). In post hoc subgroup analysis, pooled estimates (relative risks) for all-cause death were 1.78 (95% CI, 1.78-2.52) for patients <65 years old, and not significant in the older subgroup (RR, 1.26; 95% CI, 0.99-1.62).


Orthostatic hypotension is associated with increased risk of all-cause death, incident CHD, HF, and stroke.


OH is very prevalent in older adults. The current meta-analysis suggests an association between OH and adverse outcomes. This association is stronger among younger individuals; as the authors opine, this observation may indicate a more severe form of disease in younger adults with OH or greater cumulative exposure to disease. While valuable, the results from this study are not able to establish whether OH is a causal mechanism of adverse outcomes.

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Cause of Death, Coronary Artery Disease, Coronary Disease, Geriatrics, Heart Failure, Hypotension, Orthostatic, Mortality, Morbidity, Prospective Studies, Risk, Stroke

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