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Eur J Epidemiol (2011) 26:537546 DOI 10.1007/s10654-011-9578-1
CARDIOVASCULAR DISEASE
Early postural blood pressure response and cause-specic mortality among middle-aged adults
Artur Fedorowski Bo Hedblad Olle Melander
Received: 9 December 2010 / Accepted: 31 March 2011 / Published online: 13 April 2011 The Author(s) 2011. This article is published with open access at Springerlink.com
Abstract Orthostatic hypotension (OH) is associated with increased total mortality but contribution of specic death causes has not been thoroughly explored. In this prospective study, authors followed up 32,068 individuals without baseline history of cancer or cardiovascular disease (69% men; mean age, 46 years; range, 2661 years) over a period of 24 years. Hazard ratios (HRs) for total and cause-specic mortality associated with presence of OH and by quartiles of postural systolic blood pressure response (DSBP) were assessed using multivariate adjusted Cox regression model. A total of 7,145 deaths (22.3%, 9.4 deaths/1,000 person-years) occurred during follow-up. Those with OH (n = 1,943) had higher risk of death due to injury (HR, 1.88;1.372.57) and neurological disease (HR, 2.21; 1.393.51). Analogically, risk of death caused by injury and neurological disease increased across the quartiles of DSBP from hyper- (Q1SBP, ?8.5 4.7 mmHg) to hypotensive
response (Q4SBP, -13.7 5.7 mmHg; HR, 1.32;
1.001.72, and 1.84; 1.202.82, respectively) as did also risk of death due to respiratory disease (Q4SBP vs. Q1SBP:
HR, 1.53; 1.142.04). In contrast, risk curve for cerebrovascular death was U-shaped with nadir in the mildly hypotensive 3rd quartile of DSBP (-5.0 0.1 mmHg,
Q3SBP vs. Q1SBP: HR, 0.75; 0.541.03; P for linear trend = 0.021). Additionally, cardiovascular mortality was increased among 5,805 rescreened participants (mean age, 53 years; 9.8% OH positive: HR, 1.54; 1.241.89, and
Q4SBP vs. Q1SBP: 1.27; 1.021.57, respectively). In summary, increased mortality predicted by blood pressure fall on standing is associated with injuries, neurodegenerative, and respiratory diseases, as well as with cardiovascular disease in older adults. Moreover, both increase and pronounced decrease of SBP during early orthostasis indicate higher risk of cerebrovascular death.
Keywords Orthostatic hypotension Baroreex
Blood pressure Injuries Neurodegenerative diseases
Cerebrovascular disease
AbbreviationsOH Orthostatic hypotensionMPP Malm Preventive ProjectCVD Cardiovascular diseaseBMI Body-mass indexSBP Systolic blood pressureDBP Diastolic blood pressureICD International Classication of Diseases IHD Ischaemic heart diseaseCOPD Chronic obstructive pulmonary disease
Introduction
Orthostatic hypotension (OH), a relatively common manifestation...