Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies
Key result
Orthostatic hypotension is linked to ~50% higher mortality and increased CHD, HF, and stroke risk.
- RR 1.50
- 95% CI 1.24-1.81
- n=121,913
Why the study?
Whether orthostatic hypotension is a risk factor for cardiovascular morbidity and death remains uncertain, with existing evidence deriving from non-homogeneous and partly ambiguous studies.
Does the presence of orthostatic hypotension increase the risk of all-cause death and major adverse cardiac and cerebrovascular events?
Population
121 913 patients across 13 prospective observational studies
Comparison
Occurrence vs absence of orthostatic hypotension
Design
Meta-analysis of prospective observational studies
Follow-up
Median of 6 years
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
PAPeter A. BradyCardiovascular diseases division, Mayo Clinic
“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.”
“The most likely explanation for this finding is that the presence of orthostatic hypotension in younger individuals is a sign of more severe disease, probably of a neurodegenerative etiology, and that in older individuals prevalent comorbidities contribute to weaken the magnitude of effect. Moreover, the exposure time is longer when a disease starts at a younger age.”
Implication
May represent useful prognostic marker in CV practice; leaves open causality and value of intervention per future RCTs.
Key Points
- The research aims to evaluate if orthostatic hypotension increases risks of cardiovascular morbidity and mortality.
- Conducted a meta-analysis of prospective observational studies published from 1966 to 2013.
- Assessed the association between prevalent orthostatic hypotension and mortality as well as major adverse cardiac events.
- Performed subgroup analyses stratified by age and meta-regression analysis.
- Identified 13 studies with a population of 121,913 patients and a median follow-up of 6 years.
- Orthostatic hypotension associated with increased all-cause death risk (RR 1.50; 95% CI 1.24-1.81).
- Risk for incident coronary heart disease was RR 1.41 (95% CI 1.22-1.63), heart failure RR 2.25 (95% CI 1.52-3.33), and stroke RR 1.64 (95% CI 1.13-2.37).
Study Design
Type
Meta-Analysis (n=121,913)
Structured PICO
Does the presence of orthostatic hypotension increase the risk of all-cause death and major adverse cardiac and cerebrovascular events?
P
Population
13 prospective observational studies including an overall population of 121,913 patients
I
Intervention
Presence of orthostatic hypotension (OH)
C
Comparator
Absence of orthostatic hypotension
O
Outcome
All-cause death at the longest follow-uphard clinical
Main Result
Effect estimate: RR 1.50 (95% CI 1.24-1.81)
Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke, highlighting its prognostic importance.
Cite This Study
Ricci et al. (2015) 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.