Cardiovascular Outcomes in Initial and Sustained Orthostatic Hypotension: A Retrospective Cohort Study

Abstract

Classic orthostatic hypotension (OH) is a common geriatric disorder and is associated with cardiovascular risk. There is so far too few data available on the prognostic importance of initial OH and the comparison with sustained OH. This study investigated cardiovascular outcomes in initial and sustained OH in a cohort of patients aged ≥50 years. The study included 435 participants; 94 (21.6%) patients had initial (43, 45.7%) or sustained (51, 54.3%) OH, diagnosed by an active orthostatic test using the CNAP monitor. The median follow-up period was 65 months (inter-quartile range, 30 to 71). One hundred and fifty-nine (36.6%) of the patients had the primary outcome (a composite of major adverse cardiovascular events [MACE] and death from any cause), among which 142 (32.6%) had MACE, and 21 (4.8%) died. Analysis through Kaplan–Meier and further Cox regression models for multivariable adjustment both showed that, initial OH increased both the risk of the primary outcome and MACE (HR 2.20, 95% CI 1.39 to 3.50; HR 2.38, 95% CI 1.48 to 3.84), while didn't increase the mortality. In contrast, sustained OH increased both the risk of the primary outcome and MACE (HR 1.77, 95% CI 1.17 to 2.69; HR 1.71, 95% CI 1.09 to 2.70), as well as the mortality (HR 3.32, 95% CI 1.29 to 8.50). In conclusion, the preliminary exploration of this relatively small-sample study indicates that, OH, no matter initial or sustained OH, increased the cardiovascular risk in patients aged ≥50 years, while only sustained OH increased the risk of mortality.