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Hu J, Chi J, Cai H, Wu N, Li P, Huang Y, Lin C, Lai Y, Huang J, Li W, Su P, Li M, Lin Z, Xu L. Effect of orthostatic hypotension on long-term prognosis of elderly patients with stable coronary artery disease: a retrospective cohort study. Front Cardiovasc Med 2024; 11:1342379. [PMID: 38682102 PMCID: PMC11048043 DOI: 10.3389/fcvm.2024.1342379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Background The long-term prognosis of patients with stable coronary artery disease (CAD) combined with orthostatic hypotension (OH) has rarely been reported. This research was designed to examine whether OH increases the risk of all-cause mortality and cardiovascular death among patients with stable CAD. Methods We retrospectively analyzed retired military personnel over 65 years of age who were hospitalized at the General Hospital of Southern Theater Command of the Chinese People's Liberation Army between March and July 2010. A total of 924 patients with stable CAD were included, among whom 263 had OH. The risk of all-cause mortality and cardiovascular death in OH and non-OH groups were analyzed with the Cox proportional hazards models, and restricted cubic spline plots were utilized for subgroup analyses. Furthermore, competing risk models were applied for sensitivity analyses. Results The median age of the patients was 82.00 (80.00-85.00) years. Over 159 months of follow-up, the loss to follow-up rate was 2.27%, and all-cause mortality was observed in 574 (63.57%) patients, including 184 with OH. Moreover, cardiovascular death occurred in 127 patients (13.73%), with 58 cases associated with OH. Although the relationship between OH and all-cause mortality was non-significant [body mass index (BMI) < 25 group, adjusted hazard ratio (HR) = 1.10 with a 95% confidence interval (CI): 0.82-1.40; BMI ≥ 25 group, adjusted HR = 1.30, 95% CI: 0.98-1.70], it was independently related to a growing risk of cardiovascular death (adjusted HR = 1.80, 95% CI: 1.20-2.60). This finding was further validated by using a competing risk model (subdistribution HR = 1.74, 95% CI: 1.22-2.49). Moreover, age, low-density lipoprotein cholesterol, and frequency of hospital admissions were identified as risk factors of cardiovascular death among patients with OH (P < 0.05). Conclusion Our study, based on retired military personnel with stable CAD, found that OH led to a significantly higher risk of cardiovascular death, but it was not noticeably associated with all-cause mortality on long-term prognosis.
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Affiliation(s)
- Jiaman Hu
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianing Chi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hua Cai
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ningxia Wu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pengfei Li
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yuekang Huang
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Cailong Lin
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yingying Lai
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jianyu Huang
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Weihua Li
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Peng Su
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Min Li
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zhongqiu Lin
- The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
| | - Lin Xu
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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Geijerstam PA, Harris K, Johansson MM, Chalmers J, Nägga K, Rådholm K. Orthostatic Hypotension and Cognitive Function in Individuals 85 Years of Age: A Longitudinal Cohort Study in Sweden. Aging Dis 2024:AD.2024.0205. [PMID: 38421828 DOI: 10.14336/ad.2024.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Orthostatic hypotension (OH) is more common in the elderly and associated with increased mortality. However, its implications for 85-year-olds are not known. In the prospective observational cohort study Elderly in Linköping Screening Assessment (ELSA 85), 496 individuals in Linköping, Sweden, were followed from age 85 years with cognitive assessments. Blood pressure (BP) was measured supine and after 1, 3, 5, and 10 minutes of standing. Participants with a BP fall of ≥20 mmHg systolic or ≥10 mmHg diastolic after 1 or 3 minutes were classified as classical continuous or classical transient OH depending on whether the BP fall was sustained or not, at subsequent measurements. Those with a BP fall of the same magnitude, but only after 5 or 10 minutes were classified as delayed OH. Of participants, 329 took part in BP measurements and were included. Of these, 156 (47.4%) had classical OH (113 [34.3%] continuous classical, 38 [11.6%] transient classical), and 15 (4.6%) had delayed OH. Cognitive assessments were not markedly different between groups. After 8.6 years, 195 (59.3%) of the participants had died, and delayed vs no OH was associated with twice the risk of all-cause mortality, HR 2.15 (95% CI 1.12-4.12). Transient classical OH was associated with reduced mortality, HR 0.58 (95% CI 0.33-0.99), but not after multiple adjustments, and continuous classical OH was not associated with mortality. OH may have different implications for morbidity and mortality in 85-year-olds compared with younger populations.
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Affiliation(s)
- Peder Af Geijerstam
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Maria M Johansson
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katarina Nägga
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Kaye MG, Rutowski J, Aftab H, Pandey R, Khan R, Kalot MA, Anand R, Graham SP. Screening for orthostatic hypotension in the geriatric population in a real-world primary care setting reduces prescribed antihypertensive medications. Blood Press Monit 2023; 28:338-342. [PMID: 37661718 DOI: 10.1097/mbp.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND To determine if outpatient screening for orthostatic hypotension (OH) in the geriatric population results in fewer prescribed antihypertensive medications and if a relationship exists between OH and specific pharmacologic classes of antihypertensive medications. MATERIALS AND METHODS Patients ≥ 65 years were screened for OH, defined as a decrease in systolic blood pressure (SBP) ≥ 20 mm Hg or a decrease in diastolic blood pressure (DBP) ≥ 10 mm Hg after standing for 3 minutes. Sitting blood pressure (BP) was measured after patients had been seated quietly in an exam room. Patients then stood for approximately 3 minutes at which time standing BP was recorded. RESULTS OH prevalence was 18%. Standing DBP was significantly different between the two groups (70 mmHg ± 18, 80 mmHg ± 13, P = 0.007). Compared to patients without OH, patients with OH were more likely to have been previously prescribed beta-blockers (56% vs. 32%, P = 0.056) and potassium-sparing diuretics (11% vs. 1%, P = 0.026). Physicians discontinued an antihypertensive medication more often in patients who screened positive for OH than in to those who did not (17% vs. 4%, P = 0.037). Calcium channel blockers were the most frequently discontinued class of medication. CONCLUSION Asymptomatic OH is prevalent in geriatric patients. Screening for OH may lead to de-escalation of antihypertensive regimen and a reduction in polypharmacy. Positive screening for OH was associated with de-prescribing of antihypertensive medications. Prior use of beta-blockers and potassium-sparing diuretics was most largely associated with OH.
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Affiliation(s)
- Matthew G Kaye
- Department of Medicine, University at Buffalo (State University of New York)
| | - James Rutowski
- Department of Medicine, University at Buffalo (State University of New York)
| | - Hamza Aftab
- Department of Medicine, University at Buffalo (State University of New York)
| | - Rohan Pandey
- Department of Medicine, University at Buffalo (State University of New York)
| | - Raheel Khan
- Department of Medicine, University at Buffalo (State University of New York)
| | - Mohamad A Kalot
- Department of Medicine, University at Buffalo (State University of New York)
| | - Renata Anand
- Department of Medicine, University at Buffalo (State University of New York)
| | - Susan P Graham
- Division of Cardiology, Department of Medicine, University at Buffalo (State University of New York), Buffalo General Medical Center, Buffalo, New York, USA
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Wiersinga JHI, Rhodius-Meester HFM, Wolters FJ, Trappenburg MC, Lemstra AW, Barkhof F, Peters MJL, van der Flier WM, Muller M. Orthostatic hypotension and its association with cerebral small vessel disease in a memory clinic population. J Hypertens 2023; 41:1738-1744. [PMID: 37589676 DOI: 10.1097/hjh.0000000000003525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH), an impaired blood pressure (BP) response to postural change, has been associated with cognitive decline and dementia, possibly through cerebral small vessel disease (CSVD). We hypothesized that longer duration of BP drop and a larger BP drop is associated with increased risk of CSVD. METHODS This cross-sectional study included 3971 memory clinic patients (mean age 68 years, 45% female, 42% subjective cognitive complaints, 17% mild cognitive impairment, 41% dementia) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort. Early OH (EOH) was defined as a drop in BP of ±20 mmHg systolic and/or 10 mmHg diastolic only at 1 min after standing, and delayed/prolonged OH (DPOH) at 1 and/or 3 min after standing. Presence of CSVD [white matter hyperintensities (WMH), lacunes, microbleeds] was assessed with MRI ( n = 3584) or CT brain (n = 389). RESULTS The prevalence of early OH was 9% and of delayed/prolonged OH 18%. Age- and sex-adjusted logistic regression analyses showed that delayed/prolonged OH, but not early OH, was significantly associated with a higher burden of WMH (OR, 95%CI: 1.21, 1.00-1.46) and lacunes (OR, 95%CI 1.34, 1.06-1.69), but not microbleeds (OR, 95%CI 1.22, 0.89-1.67). When adjusting for supine SBP, these associations attenuated (ORs, 95%CI for WMH 1.04, 0.85-1.27; for lacunes 1.21, 0.91-1.62; for microbleeds 0.95, 0.68-1.31). A larger drop in SBP was associated with increased risk of WMH and microbleeds, however, when adjusted for supine SBP, this effect diminished. CONCLUSIONS Among memory clinic patients, DPOH is more common than EOH. While longer duration and larger magnitude of BP drop coincided with a higher burden of CSVD, these associations were largely explained by high supine BP.
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Affiliation(s)
- Julia H I Wiersinga
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes
| | - Hanneke F M Rhodius-Meester
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Oslo University Hospital, Department of Geriatric Medicine, Ullevål, Oslo, Norway
| | - Frank J Wolters
- Erasmus Medical Center, Department of Epidemiology, Rotterdam
- Erasmus Medical Center, Departments of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC, Rotterdam, The Netherlands
| | - Marijke C Trappenburg
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amstelland Hospital, Department of Internal Medicine section Geriatrics, Amstelveen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Amsterdam Neuroscience, Neurodegeneration, Brain Imaging, Amsterdam
| | - Mike J L Peters
- UMC Utrecht, University of Utrecht, Department of Internal Medicine section Geriatrics, Utrecht
| | - Wiesje M van der Flier
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Brain Imaging, Amsterdam
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam
| | - Majon Muller
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes
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Cuspidi C, Gherbesi E, Tadic M. Diabetes and orthostatic hypotension: are all patients created equal? J Hypertens 2023; 41:1217-1218. [PMID: 37259781 DOI: 10.1097/hjh.0000000000003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marijana Tadic
- Department of Cardiology, University Hospital 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia
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Nijskens C, Henstra M, Rhodius-Meester H, Yasar S, van Poelgeest E, Peters M, Muller M. Cardiovascular Risk Management in Persons with Dementia. J Alzheimers Dis 2023; 93:879-889. [PMID: 37125555 PMCID: PMC10258883 DOI: 10.3233/jad-230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
The number of people living with dementia, such as Alzheimer's disease, is increasing worldwide. Persons with dementia often have a high risk of atherosclerotic cardiovascular disease and they are therefore theoretically eligible for treatment of hypertension and hyperlipidemia. However, in this population, beneficial and harmful effects of cardiovascular risk management (CVRM) may be different compared to older persons without cognitive impairment. Current CVRM guidelines are based on trials from which persons with dementia were excluded. In this narrative review, we will discuss how current guidelines can be translated to persons with dementia and which aspects should be taken into account when treating hypertension and hyperlipidemia to prevent major adverse cardiovascular events (MACE). Survival time is significantly shorter in persons with dementia. We therefore suggest that since the main goal of CVRM is prevention of MACE, first of all, the patient's life expectancy and treatment wishes should be evaluated. Risk assessment tools are to be used with care, as they tend to overestimate the 5- and 10-year risk of MACE and benefit from CVRM in the prevention of MACE in persons with dementia. When the clinician and patient have decided that treatment is initiated or intensified, patients should be closely monitored since they are at high risk for adverse drugs events and overtreatment due to the natural course of blood pressure in persons with dementia. In the event of intolerance or side effects, medication should be switched or withdrawn. For persons with dementia and limited life expectancy, deprescribing should be part of usual care.
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Affiliation(s)
- Charlotte Nijskens
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Marieke Henstra
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Hanneke Rhodius-Meester
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, Amsterdam, The Netherlands
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sevil Yasar
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eveline van Poelgeest
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Mike Peters
- Department of Internal and Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
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From epidemiological observations to clinical practice: is the measure of postural blood pressure abnormal changes the new vital sign? J Hypertens 2022; 40:1088-1089. [PMID: 35703876 DOI: 10.1097/hjh.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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