Pulse lineResearch With Heart Logo

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle-Aged Adults.

TitleOrthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle-Aged Adults.
Publication TypeJournal Article
Year of Publication2018
AuthorsJuraschek SP, Daya N, Appel LJ, Miller ER, McEvoy JWilliam, Matsushita K, Ballantyne CM
Secondary AuthorsSelvin E
JournalJ Am Heart Assoc
Volume7
Issue10
Date Published2018 05 07
ISSN2047-9980
KeywordsAsymptomatic Diseases, Blood Pressure, Cardiovascular Diseases, Female, Humans, Hypotension, Orthostatic, Incidence, Male, Middle Aged, Posture, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, United States
Abstract

BACKGROUND: Although orthostatic hypotension (OH) is a well-recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial.

METHODS AND RESULTS: Participants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987-1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all-cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high-sensitivity troponin T (≥5 ng/L) and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990-1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow-up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44-2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34-2.04), stroke (HR, 1.83; 95% CI, 1.35-2.48), fatal CHD (HR, 2.77; 95% CI, 1.93-3.98), any CHD (HR, 2.00; 95% CI, 1.64-2.44), and all-cause mortality (HR, 1.68; 95% CI, 1.45-1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04-0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18-1.93), detectable high-sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16-1.93), and elevated NT-proBNP (odds ratio, 1.92; 95% CI, 1.48-2.49).

CONCLUSIONS: OH identified in community-dwelling middle-aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.

DOI10.1161/JAHA.118.008884
Alternate JournalJ Am Heart Assoc
PubMed ID29735525
PubMed Central IDPMC6015335
Grant ListHHSN268201700005I / NHLBI NIH HHS / National Heart, Lung, and Blood Institute / United States
HHSN268201700001I / NHLBI NIH HHS / National Heart, Lung, and Blood Institute / United States
R01 DK089174 / DK / NIDDK NIH HHS / United States
HHSN268201700002I / NHLBI NIH HHS / National Heart, Lung, and Blood Institute / United States
HHSN268201700003I / NHLBI NIH HHS / National Heart, Lung, and Blood Institute / United States
K23 HL135273 / HL / NHLBI NIH HHS / United States
K24 DK106414 / NIDDK NIH HHS / National Institute of Diabetes and Digestive and Kidney Diseases / United States
HHSN268201700004I / NHLBI NIH HHS / National Heart, Lung, and Blood Institute / United States