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Hypertension, Vol 19, 508-519, Copyright © 1992 by American Heart Association
GH Rutan, B Hermanson, DE Bild, SJ Kittner, F LaBaw and GS Tell
The purpose of the present study was to assess the prevalence of
orthostatic hypotension and its associations with demographic
characteristics, cardiovascular risk factors and symptomatology, prevalent
cardiovascular disease, and selected clinical measurements in the
Cardiovascular Health Study, a multicenter, observational, longitudinal
study enrolling 5,201 men and women aged 65 years and older at initial
examination. Blood pressure measurements were obtained with the subjects in
a supine position and after they had been standing for 3 minutes. The
prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or
greater decrease in systolic or 10 mm Hg or greater decrease in diastolic
blood pressure, was 16.2%. This prevalence increased to 18.2% when the
definition also included those in whom the procedure was aborted due to
dizziness upon standing. The prevalence was higher at successive ages.
Orthostatic hypotension was associated significantly with difficulty
walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent
falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of
myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50)
and transient ischemic attacks (odds ratio, 1.68; confidence interval,
1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were
not associated significantly with orthostatic hypotension. In addition,
orthostatic hypotension was associated with isolated systolic hypertension
(odds ratio, 1.35; confidence interval, 1.09, 1.68), major
electrocardiographic abnormalities (odds ratio, 1.21; confidence interval,
1.03, 1.42), and the presence of carotid artery stenosis based on
ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26).
Orthostatic hypotension was negatively associated with weight. We conclude
that orthostatic hypotension is common in the elderly and increases with
advancing age. It is associated with cardiovascular disease, particularly
those manifestations measured objectively, such as carotid stenosis. It is
associated also with general neurological symptoms, but this link may not
be causal. Differences in prevalence of and associations with orthostatic
hypotension in the present study compared with others are largely
attributed to differences in population characteristics and methodology.
ARTICLES
Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group
Department of Veterans Affairs, Memphis, Tenn.
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