Orthostatic hypotension and the incidence of coronary heart disease: the atherosclerosis risk in communities study

TLDR

We examined the association between orthostatic hypotension (OH) at baseline and the incidence of coronary heart disease (CHD) over an average of 6 years among 12,433 black and white middle‑aged men and women in the ARIC study. OH was defined as a systolic blood pressure drop of ≥20 mm Hg or a diastolic drop of ≥10 mm Hg upon standing, and CHD events included definite or probable myocardial infarctions, silent MI, and fatal CHD. Five percent of participants had OH, and those with OH had a higher risk of CHD (HR = 3.49, 95 % CI = 2.58–4.73), which was attenuated to HR = 1.85 (95 % CI = 1.31–2.63) after adjusting for age, ethnicity, gender, comorbid conditions, and CVD risk factors.

Abstract

We examined the association between orthostatic hypotension (OH) at baseline examination (1987–1989) and the incidence of coronary heart disease (CHD) over an average of 6 years, among 12,433 black and white middle-aged men and women participating in the Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a SBP decrease ≥ 20 mm Hg or a DBP decrease ≥ 10 mm Hg after changing from supine to standing. CHD events included definite or probable myocardial infarctions (MI), silent MI, and fatal CHD. Five percent of participants had OH. Prevalence increased with advancing age and was more common among those with cardiovascular disease (CVD)-related comorbidities and risk factors. Those with OH had an increased risk of CHD (hazard ratio [HR] = 3.49, 95% confidence interval [CI] = 2.58, 4.73). This association was attenuated after controlling for age, ethnicity, gender, comorbid conditions, and CVD risk factors (HR = 1.85, 95% CI = 1.31, 2.63).