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Orthostatic hypotension in genetically related hypertensive and normotensive individuals.

Fedorowski, Artur LU ; Burri, Philippe LU and Melander, Olle LU (2009) In Journal of Hypertension 27(5). p.976-982
Abstract
OBJECTIVES: Prevalence and determinants of orthostatic hypotension remain largely unexplored in younger individuals without significant burden of chronic diseases. METHODS: We investigated frequency and main associations of impaired orthostatic response in a cohort of 469 middle-aged hypertensive patients and 453 of their normotensive first-degree relatives. RESULTS: 13.4% of hypertensive and 5.5% of normotensive study participants were found to have orthostatic hypotension. In a backward logistic regression the following determinants of orthostatic hypotension were identified: sex [female, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.14-5.25, P=0.022], reduced glomerular filtration rate [OR (per ml/min/1.73 m2) 0.97, 95% CI... (More)
OBJECTIVES: Prevalence and determinants of orthostatic hypotension remain largely unexplored in younger individuals without significant burden of chronic diseases. METHODS: We investigated frequency and main associations of impaired orthostatic response in a cohort of 469 middle-aged hypertensive patients and 453 of their normotensive first-degree relatives. RESULTS: 13.4% of hypertensive and 5.5% of normotensive study participants were found to have orthostatic hypotension. In a backward logistic regression the following determinants of orthostatic hypotension were identified: sex [female, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.14-5.25, P=0.022], reduced glomerular filtration rate [OR (per ml/min/1.73 m2) 0.97, 95% CI 0.94-0.99, P=0.002], systolic [OR (per mmHg) 1.02, 95% CI 1.00-1.05, P=0.047] and diastolic blood pressure [OR (per mmHg) 1.04, 95% CI 1.00-1.09, P=0.033], and antihypertensive treatment (OR 0.41, 95% CI 0.18-0.93, P=0.034). In hypertensive patients use of angiotensin-converting enzyme inhibitors was related to lower orthostatic hypotension frequency. Percentage of orthostatic hypotension-positive patients in the highest blood pressure stratum (> or = 160 mmHg) decreased from 20.2 to 7.6, when diagnostic criteria of orthostatic hypotension were adjusted for mean systolic orthostatic reaction (2 SD value: 30 mmHg) . During follow-up (t=6.6 years) individuals with impaired orthostatic response showed a trend towards increased total mortality (OR 2.16, 95% CI 0.97-4.80, P=0.06) in a crude model. CONCLUSION: Prevalence of orthostatic hypotension in hypertensive patients is higher than in their normotensive first-degree relatives. Independently of age, sex, and elevated blood pressure, orthostatic hypotension may be additionally determined by impaired renal function. Antihypertensive treatment seems to protect from orthostatic hypotension, in particular, use of angiotensin-converting enzyme inhibitors in hypertensive patients. The diagnostic criteria of orthostatic hypotension may need adjustment for initial supine systolic blood pressure to increase clinical accuracy. The prognostic value of impaired orthostatic response regarding risk of cardiovascular disease and mortality remains uncertain and requires further studies. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Hypertension
volume
27
issue
5
pages
976 - 982
publisher
Lippincott Williams & Wilkins
external identifiers
  • WOS:000265939100009
  • PMID:19402222
  • Scopus:67649653831
ISSN
1473-5598
DOI
10.1097/HJH.0b013e3283279860
language
English
LU publication?
yes
id
f8759220-66fd-48d7-a878-be4eae20bbcf (old id 1391768)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19402222?dopt=Abstract
date added to LUP
2009-05-05 14:38:02
date last changed
2016-11-06 04:26:38
@misc{f8759220-66fd-48d7-a878-be4eae20bbcf,
  abstract     = {OBJECTIVES: Prevalence and determinants of orthostatic hypotension remain largely unexplored in younger individuals without significant burden of chronic diseases. METHODS: We investigated frequency and main associations of impaired orthostatic response in a cohort of 469 middle-aged hypertensive patients and 453 of their normotensive first-degree relatives. RESULTS: 13.4% of hypertensive and 5.5% of normotensive study participants were found to have orthostatic hypotension. In a backward logistic regression the following determinants of orthostatic hypotension were identified: sex [female, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.14-5.25, P=0.022], reduced glomerular filtration rate [OR (per ml/min/1.73 m2) 0.97, 95% CI 0.94-0.99, P=0.002], systolic [OR (per mmHg) 1.02, 95% CI 1.00-1.05, P=0.047] and diastolic blood pressure [OR (per mmHg) 1.04, 95% CI 1.00-1.09, P=0.033], and antihypertensive treatment (OR 0.41, 95% CI 0.18-0.93, P=0.034). In hypertensive patients use of angiotensin-converting enzyme inhibitors was related to lower orthostatic hypotension frequency. Percentage of orthostatic hypotension-positive patients in the highest blood pressure stratum (> or = 160 mmHg) decreased from 20.2 to 7.6, when diagnostic criteria of orthostatic hypotension were adjusted for mean systolic orthostatic reaction (2 SD value: 30 mmHg) . During follow-up (t=6.6 years) individuals with impaired orthostatic response showed a trend towards increased total mortality (OR 2.16, 95% CI 0.97-4.80, P=0.06) in a crude model. CONCLUSION: Prevalence of orthostatic hypotension in hypertensive patients is higher than in their normotensive first-degree relatives. Independently of age, sex, and elevated blood pressure, orthostatic hypotension may be additionally determined by impaired renal function. Antihypertensive treatment seems to protect from orthostatic hypotension, in particular, use of angiotensin-converting enzyme inhibitors in hypertensive patients. The diagnostic criteria of orthostatic hypotension may need adjustment for initial supine systolic blood pressure to increase clinical accuracy. The prognostic value of impaired orthostatic response regarding risk of cardiovascular disease and mortality remains uncertain and requires further studies.},
  author       = {Fedorowski, Artur and Burri, Philippe and Melander, Olle},
  issn         = {1473-5598},
  language     = {eng},
  number       = {5},
  pages        = {976--982},
  publisher    = {ARRAY(0x7fb8b98)},
  series       = {Journal of Hypertension},
  title        = {Orthostatic hypotension in genetically related hypertensive and normotensive individuals.},
  url          = {http://dx.doi.org/10.1097/HJH.0b013e3283279860},
  volume       = {27},
  year         = {2009},
}