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Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis

Angelousi, Annaa; Girerd, Nicolasb; Benetos, Athanasec; Frimat, Lucd; Gautier, Sylviec; Weryha, Georgesa; Boivin, Jean-Marcb

doi: 10.1097/HJH.0000000000000235

Objective: Several studies have suggested that orthostatic hypotension may be an independent predictor of cardiovascular or cerebrovascular risk and all-cause mortality, particularly in a geriatric population. In 1996, a consensus defined orthostatic hypotension as a SBP fall at least 20 mmHg and/or a DBP fall at least 10 mmHg within 3 min of standing.

Methods: Pubmed and Cochrane database were searched up to October 2013 in order to identify prospective studies evaluating, in adult populations, the association between orthostatic hypotension as defined by the 1996 consensus and clinical outcome. Meta-regression was performed when sufficient data were available.

Results: A total of 28 prospective studies were found eligible for inclusion in this systematic review. Nine prospective studies found an association between orthostatic hypotension and various cardiovascular events such as coronary disease, heart failure, and arrhythmias. No association was found between orthostatic hypotension and the risk for strokes and falls in the majority of the prospective included studies. Insufficient data were available to perform a meta-analysis for strokes and falls. The meta-analysis of seven prospective studies found that orthostatic hypotension is associated with a significant increased risk for overall mortality [pooled hazard ratio in random-effects model = 1.36 (1.13–1.63), P < 0.001)].

Conclusion: This meta-analysis provides evidence that orthostatic hypotension is associated with a 36% increase in the risk of overall mortality. A systematic review of the literature suggests that orthostatic hypotension is also associated with a higher risk for cardiovascular events. Insufficient data are available to enable a precise assessment of the association of orthostatic hypotension with strokes and falls.

aDepartment of Endocrinology, Hôpital de Brabois, CHU, Vandœuvre-lès-Nancy

bClinical Investigation Center-Inserm CIC9501, Lorrain du Coeur et des Vaisseaux Louis Mathieu, Nancy

cDepartment of Geriatrics

dDepartment of Nephrology, Hôpital de Brabois, CHU, Vandœuvre-lès-Nancy, France

Correspondence to Anna Angelousi MD, 6 Rue Andromachis, 12135 Athens, Greece. Tel: +00302105742648 and +00306978167876; e-mail:

Abbreviations: CBV, cerebrovascular disease; CI, confidence interval; COH, consensus orthostatic hypotension; DOH, diastolic orthostatic hypotension; FTD, frontotemporal dementia; HTA, hypertension; MCI, mild cognitive decline; MI, myocardial infarction; NOH, neurogenic orthostatic hypotension; OHT, orthostatic hypertension; ONT, orthostatic normotensive; OR, odds ratio; PD, Parkinson disease; SD, standard deviation; SOH, systolic orthostatic hypotension

Received 27 September, 2013

Revised 1 April, 2014

Accepted 1 April, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins