Orthostatic hypotension as a risk factor for incident heart failure: The atherosclerosis risk in communities study

Christine D. Jones, Laura Loehr, Nora Franceschini, Wayne D. Rosamond, Patricia P. Chang, Eyal Shahar, David J. Couper, Kathryn M. Rose

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Heart failure causes significant morbidity and mortality. Distinguishing risk factors for incident heart failure can help identify at-risk individuals. Orthostatic hypotension may be a risk factor for incident heart failure; however, this association has not been fully explored, especially in nonwhite populations. The Atherosclerosis Risk in Communities Study included 12363 adults free of prevalent heart failure with baseline orthostatic measurements. Orthostatic hypotension was defined as a decrease of systolic blood pressure ≥20 mmHg or diastolic blood pressure ≥10 mmHg with position change from supine to standing. Incident heart failure was identified from hospitalization or death certificate disease codes. Over 17.5 years of follow-up, orthostatic hypotension was associated with incident heart failure with multivariable adjustment (hazard ratio: 1.54 [95% CI: 1.30-1.82]). This association was similar across race and sex groups. A stronger association was identified in younger individuals ≤55 years old (hazard ratio: 1.90 [95% CI: 1.41-2.55]) than in older individuals >55 years old (hazard ratio: 1.37 [95% CI: 1.12-1.69]; interaction P=0.034). The association between orthostatic hypotension and incident heart failure persisted with exclusion of those with diabetes mellitus, coronary heart disease, and those on antihypertensives or psychiatric or Parkinson disease medications. However, exclusion of those with hypertension somewhat attenuated the association (hazard ratio: 1.34 [95% CI: 1.00-1.80]). We identified orthostatic hypotension as a predictor of incident heart failure among middle-aged individuals, particularly those 45 to 55 years of age. This association may be partially mediated through hypertension. Orthostatic measures may enhance risk stratification for future heart failure development.

Original languageEnglish (US)
Pages (from-to)913-918
Number of pages6
JournalHypertension
Volume59
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Orthostatic Hypotension
Atherosclerosis
Heart Failure
Blood Pressure
Hypertension
Death Certificates
Supine Position
Antihypertensive Agents
Coronary Disease
Parkinson Disease
Psychiatry
Diabetes Mellitus
Hospitalization
Morbidity
Mortality

Keywords

  • Autoregulation
  • Circulation
  • Heart failure
  • Hypotension
  • Risk factors

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Orthostatic hypotension as a risk factor for incident heart failure : The atherosclerosis risk in communities study. / Jones, Christine D.; Loehr, Laura; Franceschini, Nora; Rosamond, Wayne D.; Chang, Patricia P.; Shahar, Eyal; Couper, David J.; Rose, Kathryn M.

In: Hypertension, Vol. 59, No. 5, 05.2012, p. 913-918.

Research output: Contribution to journalArticle

Jones, CD, Loehr, L, Franceschini, N, Rosamond, WD, Chang, PP, Shahar, E, Couper, DJ & Rose, KM 2012, 'Orthostatic hypotension as a risk factor for incident heart failure: The atherosclerosis risk in communities study', Hypertension, vol. 59, no. 5, pp. 913-918. https://doi.org/10.1161/HYPERTENSIONAHA.111.188151
Jones, Christine D. ; Loehr, Laura ; Franceschini, Nora ; Rosamond, Wayne D. ; Chang, Patricia P. ; Shahar, Eyal ; Couper, David J. ; Rose, Kathryn M. / Orthostatic hypotension as a risk factor for incident heart failure : The atherosclerosis risk in communities study. In: Hypertension. 2012 ; Vol. 59, No. 5. pp. 913-918.
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