Prevalence of orthostatic hypertension in the very elderly and its relationship to all-cause mortality

OBJECTIVE: To investigate the association with mortality of orthostatic hypertension (OHYPER) amongst the oldest old. METHODS: Two waves of community-dwelling residents born in 1920-1921 were examined at age of 85 (n = 1004) and 90 (n = 437). OHYPER, orthostatic hypotension (OHYPO), or orthostatic normotension (ONORMO) were so classified when difference of standing-sitting SBP either increased or decreased by at least 20 mmHg or not. RESULTS: Prevalence of OHYPO, ONORMO, and OHYPER was 5% (n = 48), 91% (n = 915), and 4% (n = 41) at age 85, and 9% (n = 39), 88% (n = 385), and 3% (n = 13) at age 90. There was a tendency for fewer men among OHYPER, and significantly more participants with financial hardship, higher weight, loneliness, and anemia (P < 0.05 for all) among the 85-year-olds, fewer with poor self-rated health, and more with anemia among the 90-year-olds. Sitting blood pressure was 157 ± 22/75 ± 11, 147 ± 21/74 ± 11, and 140 ± 16/74 ± 10 mmHg among OHYPO, ONORMO, and OHYPER at age 85 (P < 0.0001), and 166 ± 28/75 ± 10, 145 ± 23/69 ± 11, and 138 ± 23/74 ± 9 mmHg at age 90 (P < 0.0001). Ten-year survival were 27, 30, and 27%, respectively, at age 85 (log-rank P = 0.34). Five-year survival were 57, 67, and 55%, respectively, at age 90 (log-rank P = 0.14). In an adjusted Cox proportional hazards ratio model, OHYPER at age 85 was not associated with mortality (hazards ratio = 0.95, 95% confidence interval 0.65-1.39). The few OHYPER among 90-year-olds precluded modeling. CONCLUSION: OHYPER is quite uncommon among community-dwelling 85 and 90-year-olds and is not associated with increased mortality.