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(Circulation. 2006;114:630-636.)
© 2006 American Heart Association, Inc.

Epidemiology

Orthostatic Hypotension Predicts Mortality in Middle-Aged Adults

The Atherosclerosis Risk in Communities (ARIC) Study

Kathryn M. Rose, PhD; Marsha L. Eigenbrodt, MD, MPH; Rebecca L. Biga, PhD; David J. Couper, PhD; Kathleen C. Light, PhD; A. Richey Sharrett, MD, DrPH; Gerardo Heiss, MD, PhD

From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (K.M.R., G.H.); Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock (M.L.E.); Ross Products Division, Abbott Laboratories, Columbus, Ohio (R.L.B.); Collaborative Studies Coordinating Center, Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill (D.J.C.); Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill (K.C.L.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (A.R.S.).

Correspondence to Kathryn M. Rose, PhD, Department of Epidemiology, Bank of America Center, 137 E Franklin St, Suite 306, Chapel Hill, NC 27514. E-mail kathryn_rose{at}unc.edu

Received October 31, 2005; revision received May 18, 2006; accepted June 12, 2006.

Background— An association between orthostatic hypotension (OH) and mortality has been reported, but studies are limited to older adults or high-risk populations.

Methods and Results— We investigated the association between OH (a decrease of 20 mm Hg in systolic blood pressure or a decrease of 10 mm Hg in diastolic blood pressure on standing) and 13-year mortality among middle-aged black and white men and women from the Atherosclerosis Risk in Communities Study (1987–1989). At baseline, 674 participants (5%) had OH. All-cause mortality was higher among those with (13.7%) than without (4.2%) OH. After we controlled for ethnicity, gender, and age, the hazard ratio (HR) for OH for all-cause mortality was 2.4 (95% confidence interval [CI], 2.1 to 2.8). Adjustment for risk factors for cardiovascular disease and mortality and selected health conditions at baseline attenuated but did not completely explain this association (HR=1.7; 95% CI, 1.4 to 2.0). This association persisted among subsets that (1) excluded those who died within the first 2 years of follow-up and (2) were limited to those without coronary heart disease, cancer, stroke, diabetes, hypertension, or fair/poor perceived health status at baseline. In analyses by causes of death, a significant increased hazard of death among those with versus without OH persisted after adjustment for risk factors for cardiovascular disease (HR=2.0; 95% CI, 1.6 to 2.7) and other deaths (HR=2.1; 95% CI, 1.6 to 2.8) but not for cancer (odds ratio=1.1; 95% CI, 0.8 to 1.6).

Conclusions— OH predicts mortality in middle-aged adults. This association is only partly explained by traditional risk factors for cardiovascular disease and overall mortality.

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