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Orthostatic hypotension and health outcomes: an umbrella review of observational studies

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Key summary points

AbstractSection Aim

To investigate potential relationships between orthostatic hypotension (OH) and negative health outcomes and mortality, through an umbrella review with integrated meta-analyses.

AbstractSection Findings

Orthostatic hypotension is significantly associated with several negative outcomes in older people, but a suggestive evidence is available only for higher risk of coronary heart disease congestive heart failure, stroke, falls dementia, and all-cause mortality.

AbstractSection Message

Orthostatic hypotension seems to be significantly associated with several negative health outcomes in older people, even if only associations with coronary heart disease, congestive heart failure, stroke, falls, dementia, and all-cause mortality are supported by suggestive evidence.

Abstract

Purpose

Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses.

Methods

We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria.

Results

From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12–1.56), stroke (HR = 1.22, 95% CI 1.08–1.38), congestive heart failure (HR = 1.30, 95% CI 1.09–1.55), all-cause mortality (RR = 1.50, 95% CI 1.24–1.81), falls (OR = 1.84, 95% CI 1.39–2.44), and dementia (HR = 1.22, 95% CI 1.11–1.35).

Conclusion

The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.

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Author information

Author notes

  1. Pinar Soysal and Nicola Veronese: joint first author.

  2. Ahmet Turan Isik and Jacopo Demurtas: joint senior author.

Authors and Affiliations

  1. Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, Istanbul, Turkey

    Pinar Soysal

  2. National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy

    Nicola Veronese & Stefania Maggi

  3. The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  4. Institute for Biomedicine of Aging, Friedrich Alexander University Erlangen-Nürnberg, Nuremberg, Germany

    Gabriel Torbahn

  5. Department of Behavioural Science and Health, University College London, London, UK

    Sarah E. Jackson

  6. Department of Cancer Epidemiology and Prevention Research, Albert Health Services, Calgary, AB, Canada

    Lin Yang

  7. Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy

    Andrea Ungar, Giulia Rivasi & Martina Rafanelli

  8. Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium

    Mirko Petrovic

  9. Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

    Ahmet Turan Isik

  10. Primary Care Department Azienda USL Toscana Sud Est, 58100, Grosseto, Italy

    Jacopo Demurtas

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  1. Pinar Soysal
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The Special Interest Groups in Systematic Reviews and Meta-analyses for Healthy Ageing, and Cardiovascular Medicine of the European Society of Geriatric Medicine (EuGMS)

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Correspondence to Pinar Soysal.

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Soysal, P., Veronese, N., Smith, L. et al. Orthostatic hypotension and health outcomes: an umbrella review of observational studies. Eur Geriatr Med 10, 863–870 (2019). https://doi.org/10.1007/s41999-019-00239-4

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