Orthostatic Hypotension Predicts Mortality in Middle-Aged Adults

TLDR

Orthostatic hypotension has been linked to mortality, but prior studies focused on older adults or high‑risk groups. This study examined whether orthostatic hypotension predicts 13‑year mortality in a diverse cohort of middle‑aged adults from the Atherosclerosis Risk in Communities Study. Baseline data showed that 5 % (674 of 13,000) of participants exhibited orthostatic hypotension. Participants with orthostatic hypotension had a 13.7 % all‑cause mortality versus 4.2 % without, yielding a hazard ratio of 2.4 that reduced to 1.7 after adjusting for cardiovascular risk factors; the association remained significant in multiple sensitivity analyses and for cardiovascular and other deaths but not cancer, indicating that orthostatic hypotension predicts mortality in middle‑aged adults and is only partially explained by traditional risk factors.

Abstract

An association between orthostatic hypotension (OH) and mortality has been reported, but studies are limited to older adults or high-risk populations.We investigated the association between OH (a decrease of 20 mm Hg in systolic blood pressure or a decrease of 10 mm Hg in diastolic blood pressure on standing) and 13-year mortality among middle-aged black and white men and women from the Atherosclerosis Risk in Communities Study (1987-1989). At baseline, 674 participants (5%) had OH. All-cause mortality was higher among those with (13.7%) than without (4.2%) OH. After we controlled for ethnicity, gender, and age, the hazard ratio (HR) for OH for all-cause mortality was 2.4 (95% confidence interval [CI], 2.1 to 2.8). Adjustment for risk factors for cardiovascular disease and mortality and selected health conditions at baseline attenuated but did not completely explain this association (HR = 1.7; 95% CI, 1.4 to 2.0). This association persisted among subsets that (1) excluded those who died within the first 2 years of follow-up and (2) were limited to those without coronary heart disease, cancer, stroke, diabetes, hypertension, or fair/poor perceived health status at baseline. In analyses by causes of death, a significant increased hazard of death among those with versus without OH persisted after adjustment for risk factors for cardiovascular disease (HR = 2.0; 95% CI, 1.6 to 2.7) and other deaths (HR = 2.1; 95% CI, 1.6 to 2.8) but not for cancer (odds ratio = 1.1; 95% CI, 0.8 to 1.6).OH predicts mortality in middle-aged adults. This association is only partly explained by traditional risk factors for cardiovascular disease and overall mortality.