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JAMA Intern Med. 2017 Sep 1;177(9):1316-1323. doi: 10.1001/jamainternmed.2017.2937.

Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults.

Juraschek SP1,2,3,4, Daya N1,2,3,4, Rawlings AM1,2,3,4, Appel LJ1,2,3,4, Miller ER 3rd1,2,3,4, Windham BG5, Griswold ME5,6, Heiss G7, Selvin E1,2,3,4.

Author information

1
Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
2
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
3
The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
4
Johns Hopkins Medical Institutions, Baltimore, Maryland.
5
Department of Medicine, University of Mississippi Medical Center, Jackson.
6
Center of Biostatistics, University of Mississippi Medical Center, Jackson.
7
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.

Abstract

Importance:

Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. It is not known whether measurements performed immediately after standing predict adverse events as strongly as measurements performed closer to 3 minutes.

Objective:

To compare early vs later OH measurements and their association with history of dizziness and longitudinal adverse outcomes.

Design, Setting, and Participants:

This was a prospective cohort study of middle-aged (range, 44-66 years) participants in the Atherosclerosis Risk in Communities Study (1987-1989).

Exposures:

Orthostatic hypotension, defined as a drop in blood pressure (BP) (systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg) from the supine to standing position, was measured up to 5 times at 25-second intervals.

Main Outcomes and Measures:

We determined the association of each of the 5 OH measurements with history of dizziness on standing (logistic regression) and risk of fall, fracture, syncope, motor vehicle crashes, and all-cause mortality (Cox regression) over a median of 23 years of follow-up (through December 31, 2013).

Results:

In 11 429 participants (mean age, 54 years; 6220 [54%] were women; 2934 [26%] were black) with at least 4 OH measurements after standing, after adjustment OH assessed at measurement 1 (mean [SD], 28 [5.4] seconds; range, 21-62 seconds) was the only measurement associated with higher odds of dizziness (odds ratio [OR], 1.49; 95% CI, 1.18-1.89). Measurement 1 was associated with the highest rates of fracture, syncope, and death at 18.9, 17.0, and 31.4 per 1000 person-years. Measurement 2 was associated with the highest rate of falls and motor vehicle crashes at 13.2 and 2.5 per 1000 person-years. Furthermore, after adjustment measurement 1 was significantly associated with risk of fall (hazard ratio [HR], 1.22; 95% CI, 1.03-1.44), fracture (HR, 1.16; 95% CI, 1.01-1.34), syncope (HR, 1.40; 95% CI, 1.20-1.63), and mortality (HR, 1.36; 95% CI, 1.23-1.51). Measurement 2 (mean [SD], 53 [7.5] seconds; range, 43-83 seconds) was associated with all long-term outcomes, including motor vehicle crashes (HR, 1.43; 95% CI, 1.04-1.96). Measurements obtained after 1 minute were not associated with dizziness and were inconsistently associated with individual long-term outcomes.

Conclusions and Relevance:

In contrast with prevailing recommendations, OH measurements performed within 1 minute of standing were the most strongly related to dizziness and individual adverse outcomes, suggesting that OH be assessed within 1 minute of standing.

PMID:
28738139
PMCID:
PMC5661881
DOI:
10.1001/jamainternmed.2017.2937
[Indexed for MEDLINE]
Free PMC Article

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