Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial. Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic...

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Autores principales:	Stephen P. Juraschek, Natalie Daya, Lawrence J. Appel, Edgar R. Miller, John William McEvoy, Kunihiro Matsushita, Christie M. Ballantyne, Elizabeth Selvin
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2018
Materias:	cardiovascular disease heart failure high‐sensitivity troponin mortality NT‐proBNP orthostatic hypotension Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/0fc51c54eeb34b96a02e5face6de54d5
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spelling	oai:doaj.org-article:0fc51c54eeb34b96a02e5face6de54d52021-11-12T17:01:48ZOrthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults10.1161/JAHA.118.0088842047-9980https://doaj.org/article/0fc51c54eeb34b96a02e5face6de54d52018-05-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.118.008884https://doaj.org/toc/2047-9980BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial. Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49). ConclusionsOH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.Stephen P. JuraschekNatalie DayaLawrence J. AppelEdgar R. MillerJohn William McEvoyKunihiro MatsushitaChristie M. BallantyneElizabeth SelvinWileyarticlecardiovascular diseaseheart failurehigh‐sensitivity troponinmortalityNT‐proBNPorthostatic hypotensionDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 10 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiovascular disease heart failure high‐sensitivity troponin mortality NT‐proBNP orthostatic hypotension Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	cardiovascular disease heart failure high‐sensitivity troponin mortality NT‐proBNP orthostatic hypotension Diseases of the circulatory (Cardiovascular) system RC666-701 Stephen P. Juraschek Natalie Daya Lawrence J. Appel Edgar R. Miller John William McEvoy Kunihiro Matsushita Christie M. Ballantyne Elizabeth Selvin Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults
description	BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial. Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49). ConclusionsOH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.
format	article
author	Stephen P. Juraschek Natalie Daya Lawrence J. Appel Edgar R. Miller John William McEvoy Kunihiro Matsushita Christie M. Ballantyne Elizabeth Selvin
author_facet	Stephen P. Juraschek Natalie Daya Lawrence J. Appel Edgar R. Miller John William McEvoy Kunihiro Matsushita Christie M. Ballantyne Elizabeth Selvin
author_sort	Stephen P. Juraschek
title	Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults
title_short	Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults
title_full	Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults
title_fullStr	Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults
title_full_unstemmed	Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults
title_sort	orthostatic hypotension and risk of clinical and subclinical cardiovascular disease in middle‐aged adults
publisher	Wiley
publishDate	2018
url	https://doaj.org/article/0fc51c54eeb34b96a02e5face6de54d5
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Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

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