ORTHOSTATIC HYPOTENSION AND MORTALITY RISK IN GERIATRIC OUTPATIENTS: THE IMPACT OF DURATION AND MAGNITUDE OF THE BLOOD PRESSURE DROP

Abstract

Objective: Orthostatic hypotension (OH) is a common condition associated with an increased mortality risk. This study investigates this association specifically in geriatric outpatients and additionally ocuses on the duration and magnitude of OH. Design and method: In this observational prospective cohort study with geriatric outpatients from the Amsterdam Ageing cohort, we differentiated OH in Early OH (EOH) and delayed/prolonged OH (DPOH). The magnitude of drop in both systolic and diastolic blood pressure (BP) after either 1 or 3 minutes was quantified. Mortality data was obtained from the Dutch municipal register. Cox proportional hazard models were used to determine the association between OH and mortality, adjusted for sex and age (model 1), additionally adjusted for OH-inducing drugs and SBP (model 2) and the presence of cardiovascular disease and diabetes (model 3). Stratified analyses in patients with geriatric deficits were performed. Results: We included 1240 patients (mean age 79.4 ± 6.9years, 52.6% females). Prevalence of OH was 443 (34.9%); 148 (11.9%) patients had EOH and 285 (23.0%) DPOH. DPOH was associated with a higher mortality risk (HR,95%CI: 1.69(1.28–2.22)) whereas EOH was not associated with mortality risk. This association did not differ in patients with geriatric deficits. Furthermore, the magnitude of drop in both systolic and diastolic BP was associated with a higher mortality risk (see figure for results of SBP). Conclusions: The presence of DPOH and the magnitude of both systolic and diastolic OH are related to an increased mortality risk in geriatric outpatients. Whether the duration of OH and magnitude of the drop in blood pressure is causally related to mortality risk or whether it is a sign of decreased resilience remains to be elucidated.