Prolonged orthostatic hypotension tied to mortality risk in elderly outpatients: Study
Netherlands: In geriatric outpatients delayed/prolonged orthostatic hypotension (DPOH) and magnitude of both systolic and diastolic orthostatic hypotension are associated with an increased mortality risk, a recent study has revealed.
"It, however, remains to be elucidated whether the duration of orthostatic hypotension and magnitude of the drop in blood pressure is causally related to mortality risk or is a sign of decreased resilience," Julia H.I. Wiersinga and Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, and colleagues wrote in their study published in the Journal of Hypertension.
Orthostatic hypotension is a common condition tied to an increased risk of mortality. The researcher's team aimed to investigate this association specifically in geriatric outpatients and additionally focuses on the duration and magnitude of orthostatic hypotension in an observational prospective cohort study with geriatric outpatients from the Amsterdam Ageing cohort.
In the study, the researchers differentiated orthostatic hypotension in early orthostatic hypotension (EOH) and delayed/prolonged orthostatic hypotension. Quantification of the magnitude of the drop in both SBP and DBP after either 1 or 3 min was done. Mortality data were obtained from the Dutch municipal register.
The association between orthostatic hypotension and mortality after adjusting for sex and age (model 1) was determined using Cox proportional hazard models, additionally adjusted for orthostatic hypotension-inducing drugs + SBP (model 2) and the presence of cardiovascular disease and diabetes (model 3). Stratified analyses in patients with geriatric deficits were also done.
The findings of the study were as follows:
- 1240 patients (mean age 79.4 ± 6.9 years, 52.6% women) were included.
- The prevalence of orthostatic hypotension was 34.9%; 11.9% of patients had EOH and 23% DPOH.
- DPOH was associated with a higher mortality risk whereas EOH was not associated with mortality risk. This association did not differ in patients with geriatric deficits.
- The magnitude of the drop in both SBP and DBP was associated with higher mortality risk.
"The magnitude of both systolic and diastolic orthostatic hypotension and the presence of DPOH is related to an increased mortality risk in geriatric outpatients," the authors wrote.
"Whether the duration of orthostatic hypotension and magnitude of the drop in blood pressure is causally related to mortality risk or whether it is a sign of decreased resilience remains to be explained," they concluded.
Reference:
Wiersinga, Julia H.I.a; Muller, Majona; Rhodius-Meester, Hanneke F.M.a,b; De Kroon, Renske M.a; Peters, Mike J.L.a,c; Trappenburg, Marijke C.a,d Orthostatic hypotension and mortality risk in geriatric outpatients: the impact of duration and magnitude of the blood pressure drop, Journal of Hypertension: June 2022 - Volume 40 - Issue 6 - p 1107-1114 doi: 10.1097/HJH.0000000000003097
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