Consequences of orthostatic blood pressure variability in middle-aged men (The Malmö Preventive Project)

OBJECTIVE: To investigate the determinants and consequences of orthostatic hypotension in the middle-aged segment of the general population. METHODS: A population of 5722 men aged 52.6 +/- 3.6 years, previously included in the Malmö Preventive Project (n = 22 444 men), was re-screened after 5.6 +/- 1.0 years and thereafter followed up over a period of 19.6 +/- 5.3 years. RESULTS: At re-screening, 566 (9.9%) participants were found to have orthostatic hypotension according to international consensus criteria, of these 365 (64.5%) demonstrated systolic impairment only. In a multivariate adjusted logistic regression model, age, low BMI, hypertension, increased heart rate, antihypertensive treatment, diabetes and current smoking independently determined orthostatic hypotension, but systolic impairment also showed association with higher pulse pressure and reduced glomerular filtration rate. In a multivariate adjusted Cox proportional hazard model, men with orthostatic hypotension demonstrated a higher risk of incident coronary event, stroke and all-cause mortality than men without orthostatic hypotension. Systolic impairment was a better predictor of all studied endpoints than were the combined criteria of orthostatic hypotension. Moreover, participants with orthostatic hypotension at both baseline and re-screening showed the highest risk of any adverse event (hazard risk 1.76, 95% confidence interval 1.28-2.43, P = 0.001), exceeding the risk predicted by orthostatic hypotension at re-screening only (hazard risk 1.22, 95% confidence interval 1.07-1.38, P = 0.003). CONCLUSION: Orthostatic hypotension may be found in up to 10% of middle-aged men and correlates with well known cardiovascular risk factors such as hypertension, smoking, diabetes and kidney failure. Orthostatic impairment seems to constitute an independent cardiovascular risk factor and may be practically estimated by systolic reaction only. As orthostatic reaction may vary over time, repeated measurements or more accurate diagnostic methods are recommended to identify high-risk patients with persistent orthostatic hypotension.