Rose KM, Eigenbrodt ML, Biga RL, Couper DJ, Light KC, Sharrett AR, et al. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study

University of Arkansas at Little Rock, Little Rock, Arkansas, United States
Circulation (Impact Factor: 14.43). 09/2006; 114(7):630-6. DOI: 10.1161/CIRCULATIONAHA.105.598722
Source: PubMed

ABSTRACT An association between orthostatic hypotension (OH) and mortality has been reported, but studies are limited to older adults or high-risk populations.
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).
OH predicts mortality in middle-aged adults. This association is only partly explained by traditional risk factors for cardiovascular disease and overall mortality.

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Available from: Marsha L Eigenbrodt, Jun 03, 2015
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    • "Considering that heart-rate variability is inversely related to blood-pressure variability, it is possible that PTSD is also associated with OH, whereby inadequate sympathetically mediated vasoconstriction renders individuals vulnerable to substantial drops in blood pressure (Rose et al., 2006). Indeed, one study found that Gulf War veterans with PTSD experienced greater immediate and delayed reductions in systolic blood pressure (SBP)— but not diastolic blood pressure (DBP)—than controls after standing up from a supine position (Peckerman et al., 2003). "
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    ABSTRACT: The purpose of this research is (a) to evaluate differences in orthostatic hypotension (OH) among young adults with and without posttraumatic stress disorder (PTSD) and (b) to examine whether group differences may be attributable to behavioral risk factors frequently associated with PTSD. Volunteers and U.S. veterans 18 to 39 years old (N = 222) completed a semistructured interview assessment of PTSD status. Direct measurements were obtained for supine and standing systolic and diastolic blood pressure at study visits, as well as height and weight, from which body mass index (BMI) was calculated. After controlling for use of psychotropic medications, a logistic regression model revealed that PTSD status was positively associated with OH, such that participants with PTSD were at 4.51 greater odds of having OH than control participants. Moreover, this effect was partially mediated by lifetime alcohol dependence (bootstrapped 95% confidence interval [-0.83, -0.20]). Overall, PTSD may pose a significant risk for OH among younger adults. In the present sample, this relationship was primarily driven by the disproportionately high history of alcohol dependence among individuals with PTSD. These results suggest that traditional therapy for PTSD should be coupled with treatment for alcohol dependency, when applicable, to reap both psychological and physiological benefits. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychological Trauma Theory Research Practice and Policy 11/2014; 7(3). DOI:10.1037/a0036716 · 2.31 Impact Factor
    • "Hypotension, including orthostatic hypotension, is associated with significant morbidity and mortality (Mukai and Lipsitz 2002). Furthermore, it has been identified as serious risk factor for stroke and coronary artery disease in the elderly (Eigenbrodt et al. 2000; Jones et al. 2012; Masaki et al. 1998; Rose et al. 2006). Fedorowski et al. (2010) reported an increased risk for cardiac events and all-cause mortality in middle-aged individuals suffering from hypotension. "
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    ABSTRACT: The present study investigated the effects of repeated administration of Korodin®, a combination of camphor and crataegus berry extract, on blood pressure and attentional functioning. This study was conducted based on a randomized, placebo-controlled, double-blind design. 54 persons participated (33 female, 21 male) with a mean age of 24.3 years. Blood pressure and body mass index were in the normal range. Participants received 20 drops of either Korodin® or a placebo for four times with interjacent time intervals of about 10 min. Blood pressure was measured sphygmomanometrically before and after each administration. Attentional performance was quantified by using two paper-and-pencil tests, the d2 Test of Attention and Digit Symbol Test. Greater increases in blood pressure occurred after the four Korodin® administrations in comparison to the four placebo administrations. The performance in two parameters of d2 Test of Attention was consistently superior after the intake of Korodin®. The excellent tolerability and safety of Korodin®, even after a total consumption of 80 drops, was confirmed.
    Phytomedicine 09/2014; 21(11):1349–1355. DOI:10.1016/j.phymed.2014.06.014 · 3.13 Impact Factor
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    • "In addition to the aging effects, OH is more prevalent in hypertensive [8, 9], neurological [10], and diabetic patients [11, 12]. The all-cause mortality rate was higher in patients with OH than in those without OH [6, 7] "
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    ABSTRACT: Orthostatic hypotension (OH) is defined by a 20-mm Hg difference of systolic blood pressure (dtSBP) and/or a 10-mm Hg difference of diastolic blood pressure (dtDBP) between supine and standing, and OH is associated with a failure of the cardiovascular reflex to maintain blood pressure on standing from a supine position. To understand the underlying genetic factors for OH traits (OH, dtSBP, and dtDBP), genome-wide association studies (GWASs) using 333,651 single nucleotide polymorphisms (SNPs) were conducted separately for two population-based cohorts, Ansung (n = 3,173) and Ansan (n = 3,255). We identified 8 SNPs (5 SNPs for dtSBP and 3 SNPs for dtDBP) that were repeatedly associated in both the Ansung and Ansan cohorts and had p-values of <1 × 10(-5) in the meta-analysis. Unfortunately, the SNPs of the OH case control GWAS did not pass our p-value criteria. Four of 8 SNPs were located in the intergenic region of chromosome 2, and the nearest gene (CTNNA2) was located at 1 Mb of distance. CTNNA2 is a linker between cadherin adhesion receptors and the actin cytoskeleton and is essential for stabilizing dendritic spines in rodent hippocampal neurons. Although there is no report about the function in blood pressure regulation, hippocampal neurons interact primarily with the autonomic nervous system and might be related to OH. The remaining SNPs, rs7098785 of dtSBP trait and rs6892553, rs16887217, and rs4959677 of dtDBP trait were located in the PIK3AP1 intron, ACTBL2-3' flanking, STAR intron, and intergenic region, respectively, but there was no clear functional link to blood pressure regulation.
    09/2013; 11(3):129-134. DOI:10.5808/GI.2013.11.3.129
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