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Prevalence of orthostatic hypotension

Abstract

Orthostatic hypotension (OH) is defined as a fall in blood pressure of at least 20 mmHg systolic or 10 mmHg diastolic when standing or during head-up tilt testing. The prevalence of OH increases with age, with disorders that affect autonomic nerve transmission, and with increasingly severe orthostatic stress. In normal elderly subjects, the prevalence of OH is reported to be between 5 and 30%. The actual prevalence depends on the conditions during diagnostic testing, such as the frequency of blood pressure recordings, the time of day and the degree of orthostatic stress. Elderly subjects are often taking medications, such as antihypertensives and diuretics that can cause or aggravate OH. Neurological diseases such as diabetic neuropathy, Parkinson’s disease, multiple system atrophy and the autonomic neuropathies further increase the likelihood of OH. The development of OH in normal subjects is associated with an increased mortality rate. OH in diabetes is also associated with a significant increase in mortality rate.

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References

  1. Allcock LM, Ullyart K, Kenny RA, Burn DJ (2004) Frequency of orthostatic hypotension in a community based cohort of patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 75:1470–1471

    PubMed  Article  CAS  Google Scholar 

  2. Bannister R, Low PA (1997) Multiple system atrophy and pure autonomic failure. In: Low PA (ed) Clinical autonomic disorders: evaluation and management. Lippincott-Ravel, Philadelphia, pp 555–576

    Google Scholar 

  3. Caird FI, Andrews GR, Kennedy RD (1973) Effect of posture on blood pressure in the elderly. Br Heart J 35:527–530

    PubMed  Article  CAS  Google Scholar 

  4. Ewing DJ, Campbell IW, Clarke BF (1980) The natural history of diabetic autonomic neuropathy. Q J Med 49:95–108

    PubMed  CAS  Google Scholar 

  5. Hilsted J, Low PA (1997) Diabetic autonomic neuropathy. In: Low PA (ed) Clinical autonomic disorders: evaluation and management. Lippincott-Raven, Philadelphia, pp 487–507

    Google Scholar 

  6. Klein CM, Vernino S, Lennon VA, Sandroni P, Fealey RD, Benrud-Larson LM, Sletten D, Low PA (2003) The spectrum of autoimmune autonomic neuropathies. Ann Neurol 53:752–758

    PubMed  Article  Google Scholar 

  7. Kyle RA, Greipp PR (1983) Amyloidosis: clinical and laboratory features in 229 cases. Mayo Clin Proc 58:665–683

    PubMed  CAS  Google Scholar 

  8. Lennox IM, Williams BO (1980) Postural hypotension in the elderly. Clin Exp Gerontol 2:313–329

    Google Scholar 

  9. Lipsitz LA (1989) Orthostatic hypotension in the elderly. N Engl J Med 321:952–957

    PubMed  CAS  Article  Google Scholar 

  10. Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O’Brien PC, Slezak JM (1997) Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 20:1561–1568

    PubMed  Article  CAS  Google Scholar 

  11. Low PA, Benrud-Larson LM, Sletten DM, Opfer-Gehrking TL, Weigand SD, O’Brien PC, Suarez GA, Dyck PJ (2004) Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 27:2942–2947

    PubMed  Article  Google Scholar 

  12. MacLennan WJ, Hall MR, Timothy JI (1980) Postural hypotension in old age: is it a disorder of the nervous system or of blood vessels? Age Ageing 9:25–32

    PubMed  Article  CAS  Google Scholar 

  13. Mader SL (1989) Orthostatic hypotension. Med Clin North Am 73:1337–1349

    PubMed  CAS  Google Scholar 

  14. Mader SL, Josephson KR, Rubenstein LZ (1987) Low prevalence of postural hypotension among community-dwelling elderly. JAMA 258:1511–1514

    PubMed  Article  CAS  Google Scholar 

  15. Masaki KH, Schatz IJ, Burchfiel CM, Sharp DS, Chiu D, Foley D, Curb JD (1998) Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation 98:2290–2295

    PubMed  CAS  Google Scholar 

  16. Myers MG, Kearns PM, Kennedy DS, Fisher RH (1978) Postural hypotension and diuretic therapy in the elderly. Can Med Assoc J 119:581–585

    PubMed  CAS  Google Scholar 

  17. Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA (1997) Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA 277:1299–1304

    PubMed  Article  CAS  Google Scholar 

  18. Palmer KT (1983) Studies into postural hypotension in elderly patients. N Z Med J 96:43–45

    PubMed  CAS  Google Scholar 

  19. Poon IO, Braun U (2005) High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 30:173–178

    PubMed  Article  CAS  Google Scholar 

  20. Rodstein M, Zeman FD (1957) Postural blood pressure changes in the elderly. J Chronic Dis 6:581–588

    PubMed  Article  CAS  Google Scholar 

  21. Rose KM, Eigenbrodt ML, Biga RL, Couper DJ, Light KC, Sharrett AR, Heiss G (2006) Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation 114:630–636

    PubMed  Article  Google Scholar 

  22. Rutan GH, Hermanson B, Bild DE, Kittner SJ, LaBaw F, Tell GS (1992) Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension 19:508–519

    PubMed  CAS  Google Scholar 

  23. Saito Y, Matsuoka Y, Takahashi A, Ohno Y (1994) Survival of patients with multiple system atrophy. Intern Med 33:321–325

    PubMed  Article  CAS  Google Scholar 

  24. Sandroni P, Ahlskog JE, Fealey RD, Low PA (1991) Autonomic involvement in extrapyramidal and cerebellar disorders. Clin Auton Res 1:147–155

    PubMed  Article  CAS  Google Scholar 

  25. Senard JM, Rai S, Lapeyre-Mestre M, Brefel C, Rascol O, Rascol A, Montastruc JL (1997) Prevalence of orthostatic hypotension in Parkinson’s disease. J Neurol Neurosurg Psychiatr 63:584–589

    PubMed  CAS  Article  Google Scholar 

  26. Suarez GA, Fealey RD, Camilleri M, Low PA (1994) Idiopathic autonomic neuropathy: clinical, neurophysiologic, and follow-up studies on 27 patients. Neurology 44:1675–1682

    PubMed  CAS  Google Scholar 

  27. Tilvis RS, Hakala SM, Valvanne J, Erkinjuntti T (1996) Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study. J Am Geriatr Soc 44:809–814

    PubMed  CAS  Google Scholar 

  28. Wenning GK, Ben Shlomo Y, Magalhaes M, Daniel SE, Quinn NP (1994) Clinical features and natural history of multiple system atrophy. An analysis of 100 cases. Brain 117:835–845

    PubMed  Article  Google Scholar 

  29. Wood BH, Bilclough JA, Bowron A, Walker RW (2002) Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatr 72:721–725

    PubMed  Article  CAS  Google Scholar 

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Acknowledgement

This work was supported in part by National Institutes of Health (NS 32352, NS 44233, NS 43364), Mayo CTSA (U54RR 24150), and Mayo Funds. Disclosure Dr. Low has served as a cosultant for WR Medical, Viatris, Eli Lilly and Company, Chelsea Therapeutics, and Quigley Corporation.

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Correspondence to Phillip A. Low MD.

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Low, P.A. Prevalence of orthostatic hypotension. Clin Auton Res 18 (Suppl 1), 8–13 (2008). https://doi.org/10.1007/s10286-007-1001-3

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Key words

  • orthostatic hypotension
  • aging
  • neuropathy
  • mortality
  • prevalence
  • autonomic nervous system