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Published on: March 21, 2013
Cardiovascular Outcomes in Initial and Sustained Orthostatic Hypotension: A Retrospective Cohort Study
Hui Geng1, Dingfeng Fang1,2, Xiahuan Chen1
1Department of Geriatrics, Peking University First Hospital, Beijing, China.
Insights
Orthostatic hypotension (OH) increases cardiovascular risk in older adults. Initial OH elevates the risk of major adverse cardiovascular events, while sustained OH raises the risk of both cardiovascular events and mortality.
Area of Science:
- Geriatric Medicine
- Cardiovascular Research
- Clinical Epidemiology
Background:
- Orthostatic hypotension (OH) is a prevalent geriatric condition linked to cardiovascular disease.
- Limited data exist on the comparative prognostic significance of initial versus sustained OH.
- Understanding these distinctions is crucial for geriatric cardiovascular risk assessment.
Purpose of the Study:
- To investigate and compare the cardiovascular outcomes associated with initial and sustained orthostatic hypotension in patients aged 50 years and older.
- To determine the differential impact of initial and sustained OH on major adverse cardiovascular events (MACE) and all-cause mortality.
Main Methods:
- A cohort study including 435 participants aged ≥50 years.
- Diagnosis of initial or sustained OH using an active orthostatic test with the CNAP monitor.
- Kaplan-Meier survival analysis and multivariable Cox regression models were employed for outcome analysis over a median follow-up of 65 months.
Main Results:
- Of 435 participants, 94 (21.6%) had initial (43) or sustained (51) OH.
- The primary outcome (MACE and death) occurred in 159 (36.6%) patients.
- Initial OH significantly increased the risk of the primary outcome and MACE (HR 2.20 and 2.38, respectively), but not mortality.
- Sustained OH significantly increased the risk of the primary outcome, MACE (HR 1.77 and 1.71, respectively), and mortality (HR 3.32).
Conclusions:
- Both initial and sustained orthostatic hypotension increase cardiovascular risk in patients aged ≥50 years.
- Sustained OH, specifically, is associated with an increased risk of mortality.
- These findings highlight the importance of differentiating OH types for accurate cardiovascular risk stratification in older adults.
Abstract:
Classic orthostatic hypotension (OH) is a common geriatric disorder and is associated with cardiovascular risk. There is so far too few data available on the prognostic importance of initial OH and the comparison with sustained OH. This study investigated cardiovascular outcomes in initial and sustained OH in a cohort of patients aged ≥50 years. The study included 435 participants; 94 (21.6%) patients had initial (43, 45.7%) or sustained (51, 54.3%) OH, diagnosed by an active orthostatic test using the CNAP monitor. The median follow-up period was 65 months (inter-quartile range, 30 to 71). One hundred and fifty-nine (36.6%) of the patients had the primary outcome (a composite of major adverse cardiovascular events [MACE] and death from any cause), among which 142 (32.6%) had MACE, and 21 (4.8%) died. Analysis through Kaplan-Meier and further Cox regression models for multivariable adjustment both showed that, initial OH increased both the risk of the primary outcome and MACE (HR 2.20, 95% CI 1.39 to 3.50; HR 2.38, 95% CI 1.48 to 3.84), while didn't increase the mortality. In contrast, sustained OH increased both the risk of the primary outcome and MACE (HR 1.77, 95% CI 1.17 to 2.69; HR 1.71, 95% CI 1.09 to 2.70), as well as the mortality (HR 3.32, 95% CI 1.29 to 8.50). In conclusion, the preliminary exploration of this relatively small-sample study indicates that, OH, no matter initial or sustained OH, increased the cardiovascular risk in patients aged ≥50 years, while only sustained OH increased the risk of mortality.
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