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Orthostatic Hypotension and Risk of Cardiovascular Disease in Elderly People: The Rotterdam Study

Authors

  • Germaine C. Verwoert,

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Francesco U. S. Mattace-Raso MD, PhD,

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Albert Hofman MD, PhD,

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Jan Heeringa MD,

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Bruno H. C. Stricker PhD,

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Monique M. B. Breteler MD, PhD,

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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  • Jacqueline C. M. Witteman PhD

    1. From the *Department of Epidemiology and Biostatistics, Section of Geriatric Medicine, Department of Internal MedicineDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Address correspondence to JCM Witteman, PhD, Department of Epidemiology & Biostatistics, Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, the Netherlands. E-mail: j.witteman@erasmusmc.nl

Abstract

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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