Skip to main content

Advertisement

SpringerLink
Log in

Heart failure and orthostatic hypotension

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Orthostatic hypotension (OH) is traditionally defined as a fall of ≥20 mmHg in systolic and/or ≥10 mmHg in diastolic blood pressure within 3 min of active standing. OH is a common comorbidity among patients with heart failure (HF). A comprehensive review regarding the relationship between OH and HF has not been published in the English literature. Here we provide current information about concomitant HF and OH, including: pathophysiology, methods of evaluation, prevalence, risk factors, prognosis and management of OH in HF patients, as well as the incidence of HF among patients with OH. The prevalence of OH in HF ranges from 8 % among community-living individuals to 83 % in elderly hospitalized patients. Dizziness and palpitations are the most frequent OH symptoms. Main predisposing factors for OH are HF severity, non-ischemic HF etiology, prolonged bed rest, hypertension and polypharmacy. OH in HF is generally managed according to recommendations for treatment of OH in the non-HF population. However, since acceptable pharmacotherapy with fludrocortisone and midodrine is problematic in HF due to adverse effects, the management of OH is based mainly on non-pharmacologic interventions. Several prospective epidemiological studies reported that OH is independently associated with an increased risk of developing HF. Since OH is a common and frequently symptomatic condition in HF patients, its clinical implications should be emphasized. Longitudinal studies should be conducted to investigate the prognostic significance and optimal management of OH in the HF population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

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

    Article  CAS  PubMed  Google Scholar 

  2. Sclater A, Alagiakrishnan K (2004) Orthostatic hypotension: a primary care primer for assessment and treatment. Geriatrics 59:22–27

    PubMed  Google Scholar 

  3. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21:69–72

    Article  PubMed  Google Scholar 

  4. Fedorowski A, Melander O (2013) Syndromes of orthostatic intolerance: a hidden danger. J Intern Med 273:322–335

    Article  CAS  PubMed  Google Scholar 

  5. Shibao C, Lipsitz LA, Biaggioni I (2013) Evaluation and treatment of orthostatic hypotension. J Am Soc Hypertens 7:317–324

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ricci F, De Caterina R, Fedorowski A (2015) Orthostatic hypotension: epidemiology, prognosis, and treatment. J Am Coll Cardiol 66:848–860

    Article  PubMed  Google Scholar 

  7. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O (2010) Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur Heart J 31:85–91

    Article  PubMed  Google Scholar 

  8. Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, Zimarino M, De Caterina R (2015) Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J 36:1609–1617

    Article  PubMed  Google Scholar 

  9. Chou RH, Liu CJ, Chao TF, Chen SJ, Tuan TC, Chen TJ, Chen SA (2015) Association between orthostatic hypotension, mortality, and cardiovascular disease in Asians. Int J Cardiol 195:40–44

    Article  PubMed  Google Scholar 

  10. 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

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. Feldstein C, Weder AB (2012) Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens 6:27–39

    Article  PubMed  Google Scholar 

  13. McGann PE (2000) Comorbidity in heart failure in the elderly. Clin Geriatr Med 16:631–648

    Article  CAS  PubMed  Google Scholar 

  14. Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J, Stricker BH, Breteler MM, Witteman JC (2008) Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 56:1816–1820

    Article  PubMed  Google Scholar 

  15. Fedorowski A, Engström G, Hedblad B, Melander O (2010) Orthostatic hypotension predicts incidence of heart failure: the Malmö preventive project. Am J Hypertens 23:1209–1215

    Article  PubMed  Google Scholar 

  16. 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 59:913–918

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Xin W, Lin Z, Li X (2013) Orthostatic hypotension and the risk of congestive heart failure: a meta-analysis of prospective cohort studies. PLoS One 8:e63169

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Alagiakrishnan K, Patel K, Desai RV, Ahmed MB, Fonarow GC, Forman DE, White M, Aban IB, Love TE, Aronow WS, Allman RM, Anker SD, Ahmed A (2014) Orthostatic hypotension and incident heart failure in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 69:223–230

    Article  PubMed  Google Scholar 

  19. Potocka-Plazak K, Plazak W (2001) Orthostatic hypotension in elderly women with congestive heart failure. Aging Clin Exp Res 13:378–384

    Article  CAS  Google Scholar 

  20. Gorelik O, Fishlev G, Litvinov V, Almoznino-Sarafian D, Alon I, Shteinshnaider M, Chachashvily S, Modai D, Cohen N (2005) First morning standing up may be risky in acutely ill older inpatients. Blood Press 14:139–143

    Article  PubMed  Google Scholar 

  21. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  22. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128:e240–e327

    Article  PubMed  Google Scholar 

  23. Cheng JW, Nayar M (2009) A review of heart failure management in the elderly population. Am J Geriatr Pharmacother 7:233–249

    Article  CAS  PubMed  Google Scholar 

  24. Abelmann WH, Fareeduddin K (1969) Increased tolerance of orthostatic stress in patients with heart disease. Am J Cardiol 23:354–363

    Article  CAS  PubMed  Google Scholar 

  25. Cody RJ, Franklin KW, Kluger J, Laragh JH (1982) Mechanisms governing the postural response and baroreceptor abnormalities in chronic congestive heart failure: effects of acute and long-term converting-enzyme inhibition. Circulation 66:135–142

    Article  CAS  PubMed  Google Scholar 

  26. Kubo SH, Cody RJ (1983) Circulatory autoregulation in chronic congestive heart failure: responses to head-up tilt in 41 patients. Am J Cardiol 52:512–518

    Article  CAS  PubMed  Google Scholar 

  27. Cody RJ, Franklin KW, Laragh JH (1982) Postural hypotension during tilt with chronic captopril and diuretic therapy of severe congestive heat failure. Am Heart J 103:480–484

    Article  CAS  PubMed  Google Scholar 

  28. Mehagnoul-Schipper DJ, Colier WN, Hoefnagels WH, Verheugt FW, Jansen RW (2002) Effects of furosemide versus captopril on postprandial and orthostatic blood pressure and on cerebral oxygenation in patients ≥70 years of age with heart failure. Am J Cardiol 90:596–600

    Article  CAS  PubMed  Google Scholar 

  29. Räihä I, Luutonen S, Piha J, Seppänen A, Toikka T, Sourander L (1995) Prevalence, predisposing factors, and prognostic importance of postural hypotension. Arch Intern Med 155:930–935

    Article  PubMed  Google Scholar 

  30. Heseltine D, Bramble MG (1988) Loop diuretics cause less postural hypotension than thiazide diuretics in the frail elderly. Curr Med Res Opin 11:232–235

    Article  CAS  PubMed  Google Scholar 

  31. Mallion JM, Neuder Y, Ormezzano O, Rochette GB, Salvat M, Baguet JP (2008) Study of nycthemeral variations in blood pressure in patients with heart failure. Blood Press Monit 13:163–165

    Article  PubMed  Google Scholar 

  32. Massie B, Kramer B, Haughom F (1981) Postural hypotension and tachycardia during hydralazine-isosorbide dinitrate therapy for chronic heart failure. Circulation 63:658–664

    Article  CAS  PubMed  Google Scholar 

  33. Gorelik O, Almoznino-Sarafian D, Litvinov V, Alon I, Shteinshnaider M, Dotan E, Modai D, Cohen N (2009) Seating-induced postural hypotension is common in older patients with decompensated heart failure and may be prevented by lower limb compression bandaging. Gerontology 55:138–144

    Article  PubMed  Google Scholar 

  34. Gorelik O, Cohen N (2015) Seated postural hypotension. J Am Soc Hypertens 9:985–992

    Article  PubMed  Google Scholar 

  35. Veronese N, De Rui M, Bolzetta F, Zambon S, Corti MC, Baggio G, Toffanello ED, Maggi S, Crepaldi G, Perissinotto E, Manzato E, Sergi G (2015) Orthostatic changes in blood pressure and mortality in the elderly: the Pro.V.A study. Am J Hypertens 28:1248–1256

    Article  PubMed  Google Scholar 

  36. Weiss A, Beloosesky Y, Kornowski R, Yalov A, Grinblat J, Grossman E (2006) Influence of orthostatic hypotension on mortality among patients discharged from an acute geriatric ward. J Gen Intern Med 21:602–606

    Article  PubMed  PubMed Central  Google Scholar 

  37. Arbogast SD, Alshekhlee A, Hussain Z, McNeeley K, Chelimsky TC (2009) Hypotension unawareness in profound orthostatic hypotension. Am J Med 122:574–580

    Article  PubMed  Google Scholar 

  38. Kristal-Boneh E, Harari G, Weinstein Y, Green MS (1995) Factors affecting differences in supine, sitting, and standing heart rate: the Israeli CORDIS study. Aviat Space Environ Med 66:775–779

    CAS  PubMed  Google Scholar 

  39. Fedorowski A, Burri P, Melander O (2009) Orthostatic hypotension in genetically related hypertensive and normotensive individuals. J Hypertens 27:976–982

    Article  CAS  PubMed  Google Scholar 

  40. Lathers CM, Charles JB (1994) Orthostatic hypotension in patients, bed rest subjects, and astronauts. J Clin Pharmacol 34:403–417

    Article  CAS  PubMed  Google Scholar 

  41. Cohn JN (1992) Mechanisms of action and efficacy of nitrates in heart failure. Am J Cardiol 70:88–92B

    Article  Google Scholar 

  42. Gorelik O, Fishlev G, Almoznino-Sarafian D, Alon I, Weissgarten J, Shteinshnaider M, Chachashvily S, Modai D, Cohen N (2004) Lower limb compression bandaging is effective in preventing signs and symptoms of seating-induced postural hypotension. Cardiology 102:177–183

    Article  PubMed  Google Scholar 

  43. Gorelik O, Shteinshnaider M, Tzur I, Feldman L, Cohen N, Almoznino-Sarafian D (2014) Factors associated with prevention of postural hypotension by leg compression bandaging. Blood Press 23:248–254

    Article  PubMed  Google Scholar 

  44. Casiglia E, Tikhonoff V, Caffi S, Boschetti G, Giordano N, Guidotti F, Segato F, Mazza A, Grasselli C, Saugo M, Rigoni G, Guglielmi F, Martini B, Palatini P (2014) Orthostatic hypotension does not increase cardiovascular risk in the elderly at a population level. Am J Hypertens 27:81–88

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine “F”, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, 70300, Israel

    Oleg Gorelik & Natan Cohen

  2. Department of Nephrology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel

    Leonid Feldman

Authors
  1. Oleg Gorelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonid Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natan Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oleg Gorelik.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gorelik, O., Feldman, L. & Cohen, N. Heart failure and orthostatic hypotension. Heart Fail Rev 21, 529–538 (2016). https://doi.org/10.1007/s10741-016-9541-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-016-9541-z

Keywords

Search

Navigation