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Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group
G H Rutan1, B Hermanson, D E Bild
1Department of Veterans Affairs, Memphis, Tenn.
Insights
Orthostatic hypotension is common in older adults, affecting 16.2% and increasing with age. This condition is linked to cardiovascular issues like myocardial infarction and carotid stenosis, as well as mobility problems.
Area of Science:
- Gerontology
- Cardiology
- Neurology
Background:
- Orthostatic hypotension (OH) is a significant clinical finding in the elderly.
- Understanding its prevalence and associations is crucial for geriatric care.
Purpose of the Study:
- To determine the prevalence of orthostatic hypotension (OH) in individuals aged 65 and older.
- To investigate the associations between OH and demographic factors, cardiovascular risks, symptoms, and clinical measurements.
Main Methods:
- The Cardiovascular Health Study enrolled 5,201 participants aged 65+.
- Blood pressure was measured in supine and standing (3 minutes) positions.
- OH was defined by a significant drop in blood pressure upon standing.
Main Results:
- The prevalence of asymptomatic OH was 16.2%, rising to 18.2% with dizziness.
- OH prevalence increased with age and was associated with difficulty walking, falls, myocardial infarction, and transient ischemic attacks.
- Associations were also found with isolated systolic hypertension, ECG abnormalities, and carotid artery stenosis.
Conclusions:
- Orthostatic hypotension is prevalent in the elderly and rises with age.
- OH is linked to objective cardiovascular disease manifestations like carotid stenosis.
- Associations with neurological symptoms exist but may not be causal.
Abstract:
The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.