Morbidity and mortality in orthostatic hypotension

Area of Science:

• Gerontology
• Neurology
• Epidemiology

Background:

• Orthostatic hypotension (OH) is a significant clinical concern, particularly in aging populations and individuals with autonomic dysfunction.
• Prevalence rates for OH in the elderly range widely, from 16% in community dwellers to 60% in institutionalized individuals.
• OH is an independent risk factor for all-cause mortality, cardiovascular events (heart failure, stroke), and is associated with polypharmacy and comorbidities.

Purpose of the Study:

• To review the epidemiology of orthostatic hypotension (OH) in the elderly.
• To summarize the epidemiology of neurogenic OH (nOH) in patients with autonomic impairment.
• To discuss associated risk factors, medications, and comorbidities.

Main Methods:

• Literature review of epidemiological studies on OH in elderly populations.
• Analysis of prevalence data based on living situations (community vs. institutionalized).
• Review of real-world data and clinical trials examining OH risk factors and medication effects.

Main Results:

• OH prevalence increases exponentially with age, especially after 75 years.
• Common characteristics in OH patients include polypharmacy, multiple comorbidities, and high healthcare utilization.
• Epidemiology of nOH is reviewed concerning neurodegenerative disorders (Parkinson's disease, multiple system atrophy) and comorbidities like hypertension and cognitive impairment.

Conclusions:

• OH is a prevalent condition in the elderly with significant mortality and cardiovascular risks.
• Understanding the distinct epidemiology of OH and nOH is crucial for targeted management.
• Further research into medication effects, particularly antihypertensives, and comorbidities is warranted.