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on August 7, 2006

A more recent version of this article appeared on August 15, 2006

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Submitted on October 31, 2005
Revised on May 18, 2006
Accepted on June 12, 2006

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, and 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.).

^* To whom correspondence should be addressed. E-mail: kathryn_rose{at}unc.edu.

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.

Key words: hypotension, orthostatic • middle aged • mortality • cardiovascular diseases

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