The association between orthostatic hypotension and recurrent falls in nursing home residents. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmö Preventive Project)
PURPOSE Orthostatic hypotension is common among the elderly , but its relation to falls is not certain . We determined whether orthostatic hypotension , including its timing and frequency , was associated with falls in elderly nursing home residents . SUBJECTS AND METHODS We conducted a prospect i ve study of 844 elderly ( 60 years of age and older ) , long-stay residents at 40 facilities that were part of a multistate nursing home chain . All subjects were able to maintain weight-bearing for at least 1 minute .  Orthostatic hypotension was defined as a 20 mm Hg or greater decrease in systolic blood pressure from supine to st and ing , as measured after 1 or 3 minutes of st and ing on four occasions ( before or after breakfast , or before or after lunch ) . The outcome was any subsequent fall during a mean of 1.2 years of follow-up . RESULTS  Orthostatic hypotension  was present ( at least on one measurement ) in 50 % of the subjects but was not associated with subsequent falls . However , among subjects with a history of previous falls in the past 6 months , those with orthostatic hypotension had an increased risk of recurrent falls [ adjusted relative risk ( RR ) = 2.1 ; 95 % confidence interval ( CI ) , 1.4 to 3.1 ] . The risk of subsequent falls was greatest in previous fallers who had orthostatic hypotension at two or more measurements ( RR = 2.6 ; 95 % CI , 1.7 to 4.6 ) . The association between orthostatic hypotension and recurrent falls was independent of measured demographic or clinical risk factors for falls . The timing of orthostatic hypotension ( before or after meals ) did not affect the risk of falls . CONCLUSIONS Orthostatic hypotension is an independent risk factor for recurrent falls among elderly nursing home residents . Although the benefit of treating orthostatic hypotension will require further study , it may be prudent to identify high-risk residents and institute pre caution ary measures OBJECTIVES To determine the prognostic role of orthostatic hypotension for cardiovascular disease ( CVD ) and all-cause mortality in elderly people . DESIGN Prospect i ve study . SETTING Community based . PARTICIPANTS Five thous and 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 st and ing position at any of three measurements taken 1 , 2 , and 3 minutes after st and ing . 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 Aims Orthostatic hypotension ( OH ) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups , but determinants and consequences of OH in the general population are poorly studied . Methods and results Prospect i ve data of the Swedish ‘ Malmö Preventive Project ’ ( n = 33 346 , 67.3 % men , mean age 45.7 ± 7.4 years , mean follow-up 22.7 ± 6.0 years ) were analysed .  Orthostatic hypotension  was found in 6.2 % of study participants and was associated with age , female gender , hypertension , antihypertensive treatment , increased heart rate , diabetes , low BMI , and current smoking . In Cox regression analysis , individuals with OH had significantly increased all-cause mortality ( in particular those aged less than 42 years ) and coronary event ( CE ) risk . Mortality and CE risk were distinctly higher in those with systolic blood pressure ( BP ) fall ≥30 mmHg [ hazard ratio ( HR ) : 1.6 , 95 % CI 1.3–1.9 , P < 0.0001 and 1.6 , 95 % CI 1.2–2.1 , P = 0.001 ] and diastolic BP fall ≥15 mmHg ( HR : 1.4 , 95 % CI 1.1–1.9 , P = 0.024 and 1.7 , 95 % CI 1.1–2.5 , P = 0.01 ) . In addition , impaired diastolic BP response had relatively greater impact ( per mmHg ) on CE incidence than systolic reaction .  Conclusion Orthostatic hypotension can be detected in ∼6 % of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes . Presence of OH increases mortality and CE risk , independently of traditional risk factors . Although both impaired systolic and diastolic responses predict adverse events , the diastolic impairment shows stronger association with coronary disease
CONCLUSION Our meta- analysis highlights that hypovitaminosis D is associated with orthostatic hypotension , independent of potential confounders .
OBJECTIVES Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes .
Recently , interest has developed in hypovitaminosis D ( defined as low 25 hydroxiyvitamin D levels ) as a potential risk factor for orthostatic hypotension .
We conducted a systematic review and meta- analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D , including the adjustment of potential confounders ( age , sex , BMI , renal function , comorbidities , seasonality , use of antihypertensive medications , and supplementation with cholecalciferol ) .