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Eur Heart J. 2015 Jul 1;36(25):1609-17. doi: 10.1093/eurheartj/ehv093. Epub 2015 Apr 6.

Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies.

Author information

1
Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy.
2
Department of Clinical Sciences, Lund University, Clinical Research Center, Skåne University Hospital, 205-02 Malmö, Sweden.
3
Department of Biomedical Sciences, 'G. D'Annunzio' University, Chieti, Italy.
4
Institute of Cardiology, 'G. D'Annunzio' University - Chieti, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy rdecater@unich.it.

Abstract

BACKGROUND:

Whether orthostatic hypotension (OH) is a risk factor for cardiovascular morbidity and death is uncertain. Currently available evidence derives from non-homogeneous and partly ambiguous studies.

OBJECTIVE:

We aimed at assessing the relationship between OH and death or major adverse cardiac and cerebrovascular events (MACCEs) by integrating results of previous studies.

METHODS:

We performed a meta-analysis of prospective observational studies reporting on the association between prevalent OH, mortality, and incident MACCE, published from 1966 through 2013. Mantel-Haenszel pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for all-cause death were assessed as the primary endpoint at the longest follow-up; incident coronary heart disease (CHD), heart failure (HF), and stroke were assessed as secondary endpoints. We also performed post hoc subgroup analyses stratified by age and a meta-regression analysis.

RESULTS:

We identified a total of 13 studies, including an overall population of 121 913 patients, with a median follow-up of 6 years. Compared with the absence of OH, the occurrence of OH was associated with a significantly increased risk of all-cause death (RR 1.50; 95% CI 1.24-1.81), incident CHD (RR 1.41; 95% CI 1.22-1.63), HF (RR 2.25; 95% CI 1.52-3.33), and stroke (RR 1.64; 95% CI 1.13-2.37). When analysed according to age, pooled estimates of RR (95% CI) for all-cause death were 1.78 (1.25-2.52) for patients <65 years old, and 1.26 (0.99-1.62) in the older subgroup.

CONCLUSION:

Orthostatic hypotension is associated with a significantly increased risk of all-cause death, incident CHD, HF, and stroke.

KEYWORDS:

Coronary artery disease; Heart failure; Mortality; Orthostatic hypotension; Stroke

PMID:
25852216
DOI:
10.1093/eurheartj/ehv093
[Indexed for MEDLINE]

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