(Circulation. 1998;98:2290-2295.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Orthostatic Hypotension Predicts Mortality in Elderly Men
The Honolulu Heart Program
From the Honolulu Heart Program, Kuakini Medical Center, Honolulu (K.H.M., I.J.S., D.C., J.D.C.); the John A. Burns School of Medicine, University of Hawaii, Divisions of Clinical Epidemiology and Geriatrics, Honolulu (K.H.M., I.J.S., J.D.C.); the Honolulu Epidemiology Research Unit, Division of Epidemiology and Clinical Applications, the National Heart, Lung, and Blood Institute, Honolulu, Hawaii (C.M.B., D.S.S.); and the Epidemiology, Demography, and Biometry Program, the National Institute on Aging, Bethesda, Md (D.F.).
Correspondence to Kamal H. Masaki, MD, 347 North Kuakini St, HPM-9, Honolulu, HI 96817. E-mail kamal{at}hhp2.hawaii-health.com
Background—Population-based data are unavailable concerning the predictive value of orthostatic hypotension on mortality in ambulatory elderly patients, particularly minority groups.
Methods and Results—With the use of data from the Honolulu Heart
Program's fourth examination (1991 to 1993), orthostatic
hypotension was assessed in relation to subsequent 4-year all-cause
mortality among a cohort of 3522 Japanese American men 71 to 93 years
old. Blood pressure was measured in the supine position and after 3
minutes of standing, with the use of standardized methods.
Orthostatic hypotension was defined as a drop in
systolic blood pressure (SBP) of 
20 mm Hg or in
diastolic blood pressure of 10 mm Hg. Overall
prevalence of orthostatic hypotension was 6.9% and
increased with age. There was a total of 473 deaths in the cohort over
4 years; of those who died, 52 had orthostatic hypotension.
Four-year age-adjusted mortality rates in those with and without
orthostatic hypotension were 56.6 and 38.6 per 1000
person-years, respectively. With the use of Cox proportional hazards
models, after adjustment for age, smoking, diabetes mellitus, body mass
index, physical activity, seated systolic blood pressure,
antihypertensive medications, hematocrit, alcohol intake, and prevalent
stroke, coronary heart disease and cancer,
orthostatic hypotension was a significant independent
predictor of 4-year all-cause mortality (relative risk 1.64, 95% CI
1.19 to 2.26). There was a significant linear association between
change in systolic blood pressure from supine position to
standing and 4-year mortality rates (test for linear trend,
P<0.001), suggesting a dose-response relation.
Conclusions—Orthostatic hypotension is relatively uncommon, may be a marker for physical frailty, and is a significant independent predictor of 4-year all-cause mortality in this cohort of elderly ambulatory men.
Key Words: mortality • aging • men • blood pressure
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