Key result
Initial and sustained orthostatic hypotension linked to up to ~120% greater risk of MACE and death.
Why the study?
Data were limited on the prognostic importance of initial orthostatic hypotension compared with sustained orthostatic hypotension.
Does initial or sustained orthostatic hypotension increase the risk of MACE and mortality in patients aged ≥50 years?
Cohort (n=435)
Does initial or sustained orthostatic hypotension increase the risk of MACE and mortality in patients aged ≥50 years?
Hazard Ratio: 2.2 (95% CI 1.39–3.5)
Both initial and sustained orthostatic hypotension are associated with increased cardiovascular risk in older adults, though only sustained OH is significantly associated with increased all-cause mortality.
May aid risk stratification in adults ≥50; leaves open whether interventions reduce MACE or mortality.
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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Geng et al. (2025) conducted a cohort in Orthostatic hypotension (n=435). Initial and sustained orthostatic hypotension vs. No orthostatic hypotension was evaluated on Composite of major adverse cardiovascular events [MACE] and death from any cause (HR 2.20, 95% CI 1.39-3.50). Initial and sustained orthostatic hypotension both increased the risk of MACE and death (HR 2.20, 95% CI 1.39-3.50 and HR 1.77, 95% CI 1.17-2.69, respectively) in patients aged ≥50 years.
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