More evidence supports link between orthostatic hypotension and CVD
BOSTON – Orthostatic hypotension (OH) – a rapid drop in blood pressure upon standing up from a sitting or lying down position – is a frequently encountered clinical sign among patients. Clinicians most often consider OH as indicative of dehydration. However, new research led by scientists at BIDMC bolsters the notion that adults with OH may have undiagnosed cardiovascular disease.
The team analyzed data from 9,139 participants ages 45 to 64 who enrolled in the long-running Atherosclerosis Risk in Communities (ARIC) Study between 1987 and 1989. These participants were followed for cardiovascular events and mortality through Dec. 31, 2015.
"OH was associated with all measures of subclinical cardiovascular disease and was an important predictor of clinical CVD events in the future," said Stephen Juraschek, MD, PhD, Instructor of Medicine at BIDMC and Harvard Medical School. "When orthostatic hypotension is detected in middle-aged adults who do not have known cardiovascular disease, health care practitioners should be mindful of undetected heart disease."
Juraschek and colleagues' findings appeared online in the Journal of the American Heart Association on May 7.
"While there is controversy surrounding the association between OH and cardiovascular disease, our findings were unequivocal and consistent," said Juraschek. "These findings strongly support our hypothesis about OH being an important manifestation of undetected CVD. Many treatments for OH such as increasing sodium intake or stopping blood pressure medications have the potential to worsen blood pressure control and risk for CVD. Clinicians should be aware of the possibility that undiagnosed CVD may be present in adults with OH prior to starting treatments."
In addition to Juraschek, co-authors include Natalie Daya, MHS; Lawrence J. Appel, MD, MPH; Edgar R. Miller III MD, PhD; John William McEvoy, MB, BCh, BAO, MHS; Kunihiro Matsushita, MD, PhD; Christie M. Ballantyne, MD; and Elizabeth Selvin, PhD, MPH.
SPJ is supported by NIH/NHLBI grant 7K23HL135273-02. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). The authors thank the staff and participants of the ARIC study for their important contributions. Dr. Selvin was supported by NIH/NIDDK grants K24DK106414 and 2R01DK089174.