Orthostatic hypotension was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24-1.81), incident coronary heart disease, heart failure, and stroke.
Meta-Analysis (n=121,913)
Does the presence of orthostatic hypotension increase the risk of all-cause death and major adverse cardiac and cerebrovascular events?
Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke, highlighting its prognostic importance.
Effect estimate: RR 1.50 (95% CI 1.24-1.81)
Background Whether orthostatic hypotension (OH) is a risk factor for cardiovascular morbidity and death is uncertain. Currently available evidence derives from non-homogeneous and partly ambiguous studies. Objective We aimed at assessing the relationship between OH and death or major adverse cardiac and cerebrovascular events (MACCEs) by integrating results of previous studies. Methods We performed a meta-analysis of prospective observational studies reporting on the association between prevalent OH, mortality, and incident MACCE, published from 1966 through 2013. Mantel-Haenszel pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for all-cause death were assessed as the primary endpoint at the longest followup; incident coronary heart disease (CHD), heart failure (HF), and stroke were assessed as secondary endpoints. We also performed post hoc subgroup analyses stratified by age and a meta-regression analysis. Results We identified a total of 13 studies, including an overall population of 121 913 patients, with a median follow-up of 6 years. Compared with the absence of OH, the occurrence of OH was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24-1.81), incident CHD (RR 1.41; 95% CI 1.22-1.63), HF (RR 2.25; 95% CI 1.52-3.33), and stroke (RR 1.64; 95% CI 1.13-2.37). When analysed according to age, pooled estimates of RR (95% CI) for all-cause death were 1.78 (1.25-2.52) for patients < 65 years old, and 1.26 (0.99-1.62) in the older subgroup. Conclusion Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke.
“The study brings new life to an often forgotten clinical sign and justifies the routine clinical assessment of orthostatic hypotension in any individual undergoing cardiovascular evaluation since it is easy to measure, requires minimal equipment and expense, yet may provide incremental prognostic value.”
Ricci et al. (Mon,) conducted a meta-analysis in Orthostatic hypotension (n=121,913). Orthostatic hypotension vs. Absence of orthostatic hypotension was evaluated on All-cause death at the longest follow-up (RR 1.50, 95% CI 1.24-1.81). Orthostatic hypotension was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24-1.81), incident coronary heart disease, heart failure, and stroke.