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Orthostatic Hypotension and Risk of Cardiovascular Disease in Elderly People: The Rotterdam Study
Open accessAbstract
OBJECTIVES: To determine the prognostic role of orthostatic hypotension for cardiovascular disease (CVD) and all-cause mortality in elderly people. DESIGN: Prospective study. SETTING: Community based. PARTICIPANTS: Five thousand sixty-four subjects from the Rotterdam study aged 55 and older. MEASUREMENTS: Orthostatic hypotension was measured using a Dinamap automatic blood pressure recorder. Orthostatic hypotension is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to standing position at any of three measurements taken 1, 2, and 3 minutes after standing. RESULTS: At baseline, 901 subjects had orthostatic hypotension. During follow-up, 668 subjects had coronary heart disease (CHD) (mean follow-up 6.0 +/- 3.5 years), and 1,835 subjects died (mean follow-up period 7.8 +/- 3.8 years). Orthostatic hypotension increased the risk of CHD (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.08-1.57) and all-cause mortality (HR=1.22, 95% CI=1.09-1.36), in models adjusted for age and sex. The risk was slightly lower after additional adjustment for cardiovascular risk factors. In analyses stratified for age, the HRs for all-cause mortality were 1.80 (95% CI 1.25-2.60), 1.13 (0.89-1.42), and 1.27 (95% CI=1.11-1.44), in the first, second, and third tertile of age, respectively. CONCLUSION: Orthostatic hypotension increases the risk of CHD and all-cause mortality in elderly people. The risk of CVD and mortality is strongest in younger and very old subjects.
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Orthostatic hypotension is a common finding in elderly patients because of impaired baroreceptor sensitivity.
“Orthostatic hypotension is a common finding in elderly patients because of their impaired baroreceptor sensitivity [237], and is often associated with hypertension, dementia, other neurodegenerative diseases (e.g. Parkinson's disease), atrial fibrillation, diabetes and heart failure [238–241].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [237]
The paper’s introductory passage says orthostatic hypotension is common in elderly people. Neither that passage nor the Discussion attributes its prevalence to impaired baroreceptor sensitivity, so the stated cause is unsupported by our copy. The later associations in the citing sentence have separate citations and are not part of this verdict. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe total number of BP-lowering medications or the use of three or more antihypertensive drugs may be a significant predictor of OH.
“The total number of BP-lowering medications 313 or the use of three or more antihypertensive drugs may be a significant predictor of OH. 314”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [313]
The Results report that participants with orthostatic hypotension were more likely to use antihypertensive medication (P<.001), and Table 1 shows 34.3% versus 25.3%. The paper does not report whether the number of BP-lowering medications, or use of three or more drugs, predicts orthostatic hypotension; its prognostic models instead examine outcomes according to orthostatic-hypotension status. (LLM, conf=0.84)
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Metadata
- Authors
- Verwoert, G. C., Mattace‐Raso, F. U. S., Hofman, A., Heeringa, J., Stricker, B. H. C., Breteler, M. M. B., & Witteman, J. C. M.
- Affiliations
- Erasmus MC (NL)
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2008-10
- Volume
- 56
- Issue
- 10
- Pages
- 1816-1820
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2101451050
- Cited by
- 220
- References
- 28
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 6 · 2023: 12 · 2022: 15 · 2021: 4 · 2020: 20 · 2019: 26 · 2018: 22 · 2017: 7 · 2016: 12 · 2015: 25 · 2014: 17 · 2013: 7 · 2012: 15
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Licence
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- orthostatic hypotension, cardiovascular disease, coronary artery disease, all-cause mortality, older adults, prognosis, age differences, cardiovascular risk factors, blood pressure
- MeSH terms
- Aged, Cardiovascular Diseases, Coronary Disease, Female, Heart Failure, Humans, Hypotension, Orthostatic, Male, Middle Aged, Mortality, Netherlands, Risk Factors, Proportional Hazards Models, Stroke
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