Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmö Preventive Project) Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Distribution and observed associations of orthostatic blood pressure changes in elderly general medicine outpatients. Orthostatic hypotension and the risk of myocardial infarction in the home-dwelling elderly. Pretreatment orthostatic hypotension as a predictor of response to nortriptyline in geriatric depression. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older The association between orthostatic hypotension and recurrent falls in nursing home residents. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons: a randomized single-blind controlled study. l-threo-dihydroxyphenylserine (l-threo-DOPS; droxidopa) in the management of neurogenic orthostatic hypotension: A multi-national, multi-center, dose-ranging study in multiple system atrophy and pure autonomic failure Disorders of orthostatic blood pressure response are associated with cardiovascular disease and target organ damage in hypertensive patients. Orthostatic hypotension predicts incidence of heart failure: the Malmö preventive project. Orthostatic hypotension in de novo Parkinson disease. The treatment of neurogenic orthostatic hypotension with 3,4-DL-threo-dihydroxyphenylserine Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. Association of low serum 25-hydroxyvitamin D levels and high arterial blood pressure in the elderly. Randomized Withdrawal Study of Patients With Symptomatic Neurogenic Orthostatic Hypotension Responsive to Droxidopa
OBJECTIVES To determine the prognostic role of orthostatic hypotension for cardiovascular disease ( CVD ) and all-cause mortality in elderly people . DESIGN Prospect i ve study . SETTING Community based . PARTICIPANTS Five thous and sixty-four subjects from the Rotterdam study aged 55 and older . MEASUREMENTS  Orthostatic hypotension  was measured using a Dinamap automatic blood pressure recorder . Orthostatic hypotension  is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to st and ing position at any of three measurements taken 1 , 2 , and 3 minutes after st and ing . RESULTS At baseline , 901 subjects had  orthostatic hypotension  . During follow-up , 668 subjects had  coronary heart disease  ( CHD ) ( mean follow-up 6.0 + /- 3.5 years ) , and 1,835 subjects died ( mean follow-up period 7.8 + /- 3.8 years ) . Orthostatic hypotension increased the risk of CHD ( hazard ratio (HR)=1.31 , 95 % confidence interval (CI)=1.08 - 1.57 ) and all-cause mortality ( HR=1.22 , 95 % CI=1.09 - 1.36 ) , in models adjusted for age and sex . The risk was slightly lower after additional adjustment for cardiovascular risk factors . In analyses stratified for age , the HRs for all-cause mortality were 1.80 ( 95 % CI 1.25 - 2.60 ) , 1.13 ( 0.89 - 1.42 ) , and 1.27 ( 95 % CI=1.11 - 1.44 ) , in the first , second , and third tertile of age , respectively . CONCLUSION Orthostatic hypotension increases the risk of CHD and all-cause mortality in elderly people . The risk of CVD and mortality is strongest in younger and very old subjects Aims Orthostatic hypotension ( OH ) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups , but determinants and consequences of OH in the general population are poorly studied . Methods and results Prospect i ve data of the Swedish ‘ Malmö Preventive Project ’ ( n = 33 346 , 67.3 % men , mean age 45.7 ± 7.4 years , mean follow-up 22.7 ± 6.0 years ) were analysed .  Orthostatic hypotension  was found in 6.2 % of study participants and was associated with age , female gender , hypertension , antihypertensive treatment , increased heart rate , diabetes , low BMI , and current smoking . In Cox regression analysis , individuals with OH had significantly increased all-cause mortality ( in particular those aged less than 42 years ) and coronary event ( CE ) risk . Mortality and CE risk were distinctly higher in those with systolic blood pressure ( BP ) fall ≥30 mmHg [ hazard ratio ( HR ) : 1.6 , 95 % CI 1.3–1.9 , P < 0.0001 and 1.6 , 95 % CI 1.2–2.1 , P = 0.001 ] and diastolic BP fall ≥15 mmHg ( HR : 1.4 , 95 % CI 1.1–1.9 , P = 0.024 and 1.7 , 95 % CI 1.1–2.5 , P = 0.01 ) . In addition , impaired diastolic BP response had relatively greater impact ( per mmHg ) on CE incidence than systolic reaction .  Conclusion Orthostatic hypotension can be detected in ∼6 % of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes . Presence of OH increases mortality and CE risk , independently of traditional risk factors . Although both impaired systolic and diastolic responses predict adverse events , the diastolic impairment shows stronger association with coronary disease We sought to determine the prevalence of orthostatic hypotension as a cause of syncope in the emergency setting , and describe the characteristics of patients diagnosed with this condition .  Blood pressure orthostatic changes  were measured prospect ively in a st and ardized fashion up to 10 minutes , or until symptoms occurred , in all consecutive patients with syncope as a chief complaint presenting in the emergency department ( ED ) of a primary and tertiary care hospital . Patients unable to st and -up were excluded . Hypotension was considered to be the cause of syncope when there was : ( 1 ) a decrease in systolic blood pressure ( SBP ) > or= 20 mm Hg with simultaneous symptoms ; ( 2 ) a decrease in SBP between 10 and 20 mm Hg , but a SBP < or= 90 mm Hg with or without symptoms ; and ( 3 ) a nonsignificant decrease in SBP in the ED , but a prehospital value < or= 80 mm Hg was documented that prompted fluid therapy before st and ardized measurements . Among 788 patients with syncope seen in the ED during a 20-month period , 650 were included in the study , and 579 ( 89 % ) had st and ardized measurements of SBP .  According to diagnostic criteria , orthostatic hypotension was considered to be the cause of syncope in 156 of them ( 24 % ) . Fifty-eight patients ( 37 % ) had drug-induced hypotension , 33 ( 21 % ) hypovolemia , 19 ( 12 % ) postpr and ial hypotension , and 46 ( 29 % ) idiopathic hypotension . Asymptomatic SBP changes > or= 20 mm Hg were found in 10 % of patients with syncope attributed to other causes . Compared with patients with vasovagal disorder , those with orthostatic hypotension were older ; had more comorbid conditions including hypertension , organic heart disease , and abnormal electrocardiogram ; were taking more hypotensive medications ; and required more frequently hospitalization ( P < .01 ) . We concluded that st and ardized blood pressure measurement in the ED enabled to strongly implicate orthostatic hypotension as a cause of syncope in 24 % of patients with this symptom . Drug-related hypotension was the most frequent cause for this disorder Factors associated with orthostatic blood pressure change in elderly out patients were determined by surveying 398 medical clinical out patients aged 65 years and older .  Blood pressure  was measured with r and om-zero sphygmomanometers after patients were 5 minutes in a supine and 5 minutes in a st and ing position .  Orthostatic blood pressure changes were at normally distributed levels with systolic and diastolic pressures dropping an average of 4 mm Hg ( st and ard deviation [SD]=15 mm Hg ) and 2 mm Hg ( SD=11 mm Hg ) , respectively . Orthostatic blood pressure changes were unassociated with age , race , sex , body mass , time since eating , symptoms , or other factors . According to multiple linear regression analysis , supine systolic pressure , chronic obstructive pulmonary disease ( COPD ) , and diabetes mellitus were associated with a decrease in systolic pressure on st and ing . Hypertension , antiarthritic drugs , and abnormal heartbeat were associated with an increase in systolic pressure on st and ing . For orthostatic diastolic pressure changes , supine diastolic pressure and COPD were associated with a decrease in diastolic pressure on st and ing . Congestive heart failure was associated with an increase in st and ing diastolic pressure . Using logistic regression analysis , only supine systolic pressure was associated with a greater than 20-mm Hg drop in systolic pressure ( n=53 , prevalence=13 % ) . Supine diastolic pressure and COPD were the only variables associated with a greater than 20-mm Hg drop in diastolic pressure ( n=16 , prevalence=4 % ) . These factors may help physicians in identifying older persons at risk for having orthostatic hypotension OBJECTIVES We investigated the prognostic significance of orthostatic hypotension on the risk of  myocardial infa rct ion ( MI ) amongst the elderly . DESIGN Prospect i ve population -based study . SETTING Home-dwelling population . SUBJECTS Orthostatic testing was performed between 8 a.m. and 2 p.m. , irrespective of having had meals , on 792 persons , representing 82 % of all home-dwelling persons aged > or = 70 years living in five municipalities around the city of Oulu . MAIN OUTCOME MEASURES Occurrence of cases of MI were recorded during mean 3.58 ( SD 1.09 ) years follow-up period , from national mortality statistics and local hospital discharge registers . RESULTS Ninety cases of MI , of which 40 were fatal after initial hospitalization , occurred during the follow-up period . Orthostatic diastolic blood pressure ( BP ) drop 1 min after st and ing up was associated with subsequent MI , but systolic BP reactions had no predictive value . According to the Cox regression model , the strongest predictor of the occurrence of subsequent MI was found in regard to > or = 8 mmHg drop in diastolic BP 1 min after st and ing up ; adjusted for history of MI , diabetes mellitus , chest pain , use of calcium antagonist , beta-blocker , nitrate and diuretic medication , hazard ratio of MI being 2.00 ( 1.11 - 3.59 ) . CONCLUSIONS Orthostatic testing offers a novel means to assess the risk of MI amongst elderly persons .  Diastolic BP drop immediately after st and ing up identifies elderly subjects at a high risk of subsequent MI The consequences of orthostatic hypotension , a serious and common problem among the elderly , are falls , transient ischemic attacks , strokes , and myocardial infa rct ions .  Depressed elderly taking tricyclic antidepressants ( TCAs )  are at increased risk , and the pretreatment presence of orthostatic hypotension is considered a relative contraindication to TCA treatment . Recently , it was reported that the presence of pretreatment orthostatic hypotension in geriatric out patients with unipolar depression predicted good clinical response to imipramine or doxepin . We investigated the predictive value of pretreatment systolic orthostatic pressure changes ( PSOP ) in unipolar depressed elderly out patients ( mean age , 64 ) who were to receive a 16-week course of nortriptyline or interpersonal psychotherapy .  Overall , PSOP was significantly correlated with improvement on both the Beck Depression Inventory and the Hamilton Depression Rating Scale . Although both groups responded equally to treatment , PSOP was more strongly correlated with improvement on the Beck Depression Inventory ( r = 0.74 , p less than 0.01 ) in the nortriptyline-treated group than in the group treated with interpersonal therapy ( r = 0.31 , not significant ) . The nortriptyline-treated subjects with a PSOP of greater than or equal to 10 mm Hg had a greater improvement than those with a PSOP of less than 10 mm HG ( t = -2.36 , p less than 0.05 ) . No episodes of symptomatic orthostatic hypotension occurred in the nortriptyline-treated subjects . The results suggest that orthostatic hypotension , a relative contraindication to TCA use , may potentially identify patients more likely to respond to TCAs This cross-sectional analysis of a population -based cohort investigates the postural changes in blood pressure ( BP ) and heart rate and assesses the prevalence of orthostatic hypotension ( OH ) and its associations with the medicines used by an elderly population . The study population ( n=1000 ) was a r and om sample of persons aged 75 years or older in the City of Kuopio , Finl and . In 2004 , altogether , 781 persons participated in the study . After the exclusion of persons living in institutional care ( n=82 ) and those without orthostatic test ( n=46 ) , the final study population comprised 653 home-dwelling elderly persons .  OH was defined as a ⩾20 mm Hg drop of systolic BP or a ⩾10 mm Hg drop of diastolic BP or both 1 or 3 min after st and ing up from supine position . Systolic BP dropped for more than half of the home-dwelling elderly when they stood up from a supine to a st and ing position . The total prevalence of OH was 34 % ( n=220 ) . No significant gender or age differences were seen . The prevalence of OH was related to the total number of medicines in regular use ( P<0.05 ) . OH and postural changes in BP are more common among the home-dwelling elderly than reported in previous studies . The prevalence of OH is related to the number of medicines in regular use . There is an obvious need to measure orthostatic BP of elderly persons , as low BP and OH are important risk factors especially among the frail elderly persons PURPOSE Orthostatic hypotension is common among the elderly , but its relation to falls is not certain . We determined whether orthostatic hypotension , including its timing and frequency , was associated with falls in elderly nursing home residents . SUBJECTS AND METHODS We conducted a prospect i ve study of 844 elderly ( 60 years of age and older ) , long-stay residents at 40 facilities that were part of a multistate nursing home chain . All subjects were able to maintain weight-bearing for at least 1 minute .  Orthostatic hypotension was defined as a 20 mm Hg or greater decrease in systolic blood pressure from supine to st and ing , as measured after 1 or 3 minutes of st and ing on four occasions ( before or after breakfast , or before or after lunch ) . The outcome was any subsequent fall during a mean of 1.2 years of follow-up . RESULTS  Orthostatic hypotension  was present ( at least on one measurement ) in 50 % of the subjects but was not associated with subsequent falls . However , among subjects with a history of previous falls in the past 6 months , those with orthostatic hypotension had an increased risk of recurrent falls [ adjusted relative risk ( RR ) = 2.1 ; 95 % confidence interval ( CI ) , 1.4 to 3.1 ] . The risk of subsequent falls was greatest in previous fallers who had orthostatic hypotension at two or more measurements ( RR = 2.6 ; 95 % CI , 1.7 to 4.6 ) . The association between orthostatic hypotension and recurrent falls was independent of measured demographic or clinical risk factors for falls . The timing of orthostatic hypotension ( before or after meals ) did not affect the risk of falls . CONCLUSIONS Orthostatic hypotension is an independent risk factor for recurrent falls among elderly nursing home residents . Although the benefit of treating orthostatic hypotension will require further study , it may be prudent to identify high-risk residents and institute pre caution ary measures OBJECTIVES This study sought to assess the efficacy of compression b and age of legs and abdomen in preventing hypotension and symptoms . BACKGROUND Progressive orthostatic hypotension can occur in elderly people during st and ing . METHODS Twenty-one patients ( 70 + /- 11 years ) affected by symptomatic progressive orthostatic hypotension underwent 2 tilt-test procedures , with and without elastic b and age of the legs ( compression pressure 40 to 60 mm Hg ) and of the abdomen ( compression pressure 20 to 30 mm Hg ) in a r and omized crossover fashion . Leg b and age was administered for 10 min and was followed by an additional abdominal b and age for a further 10 min . Symptoms were evaluated by a 7-item Specific Symptom Score ( SSS ) question naire before and after 1 month of therapy with elastic compression stockings of the legs ( prescribed in all patients irrespective of the results of the tilt study ) . RESULTS In the control arm , systolic blood pressure decreased from 125 + /- 18 mm Hg immediately after tilting to 112 + /- 25 mm Hg after 10 min of sham leg b and age and to 106 + /- 25 mm Hg after 20 min despite the addition of sham abdominal b and age . The corresponding values with active therapy were 129 + /- 19 mm Hg , 127 + /- 17 mm Hg ( p = 0.003 vs. control ) , and 127 + /- 21 mm Hg ( p = 0.002 vs. control ) . In the active arm , 90 % of patients remained asymptomatic , versus 53 % in the control arm ( p = 0.02 ) . During the month before evaluation , the mean SSS score was 35.2 + /- 12.1 with dizziness , weakness , and palpitations accounting for 64 % of the total score . The SSS score decreased to 22.5 + /- 11.3 after 1 month of therapy ( p = 0.01 ) . CONCLUSIONS Lower limb compression b and age is effective in avoiding orthostatic systolic blood pressure decrease and in reducing symptoms in elderly patients affected by progressive orthostatic hypotension This study was design ed to determine the efficacy and tolerability of increasing doses ofl-threo-dihydroxyphenylserine ( l-threo-DOPS ) in treating  symptomatic orthostatic hypotension associated with multiple system atrophy ( MSA ) and pure autonomic failure ( PAF ) . Following a one-week run-in , patients ( 26 MSA ; 6 PAF ) with symptomatic orthostatic hypotension  received increasing doses ofl-threo-DOPS ( 100 , 200 and 300 mg , twice daily ) in an open , dose-ranging study . Incremental dose adjustment ( after weeks two and four of outpatient treatment ) was based on clinical need until blood pressure ( BP ) , and symptoms improved . Final dosage was maintained for six weeks . Withl-threo-DOPS  , systolic BP decrease was reduced during orthostatic challenge ( −22±28 mm Hg reduction from a baseline decrease of 54.3±27.7 mm Hg , p=0.0001 , n=32 ; supine systolic BP at final visit was 118.9±28.2 mm Hg ) . By the end of the study , 25 patients ( 78 % ) improved , and in 14 patients ( 44 % ) orthostatic hypotension was no longer observed . Decreased orthostatic systolic BP decrease occurred in 22 % ( 7/32 ) , 24 % ( 6/25 ) and 61 % ( 11/18 ) of patients treated with 100 , 200 , and 300 mgl-threo-DOPS twice daily , respectively . An improvement occurred in symptoms associated with orthostatic hypotension , such as light-headedness , dizziness ( p=0.0125 ) , and blurred vision (p=0.0290).l-threo-DOPS was well tolerated , with the 2 serious adverse events reported being a possible complication of the disease under study , and with no reports of supine hypertension . I conclusion , l-threo-DOPS ( 100 , 200 , and 300 mg , twice daily ) was well tolerated . The dosage of 300 mg twice dailyl-threo-DOPS seemed to offer the most effective control of symptomatic orthostatic hypotension in MSA and PAF BACKGROUND The prevalence and clinical significance of orthostatic hypertension  ( OHT ) remain largely undetermined in hypertensive patients . This study investigated the association of OHT and  orthostatic hypotension ( OH )  with cardiovascular disease ( CVD ) and target organ damage ( TOD ) in hypertensive patients . METHODS A cross-sectional study was conducted in 4,711 hypertensives and 826 normotensives , aged 40 - 75 years . OHT was defined as an increase in systolic blood pressure ( SBP ) of > or = 20 mm Hg , and OH was defined as either a reduction in SBP of at least 20 mm Hg or a reduction in diastolic BP ( DBP ) of at least 10 mm Hg during the first 3 min after st and ing . RESULTS Hypertension was only independently associated with a risk of OHT . After controlling for age , sex , and other confounders , OH was associated with peripheral artery disease ( PAD ) ( odds ratio ( OR ) 1.49 , 95 % confidence interval ( CI ) 1.15 - 1.89 , P < 0.01 ) , left ventricular hypertrophy ( LVH ) ( OR 1.48 , 95 % CI 1.12 - 1.93 , P < 0.001 ) , coronary artery disease ( CAD ) ( OR 1.71 , 95 % CI 1.12 - 2.61 , P < 0.01 ) , and stroke ( OR 1.72 , 95 % CI 1.19 - 2.34 , P < 0.01 ) , but OHT was only associated with PAD ( OR 1.36 , 95 % CI 1.05 - 1.81 , P < 0.05 ) and stroke ( OR 1.76 , 95 % CI 1.27 - 2.26 , P < 0.01 ) . The adjusted OR for PAD , predicted by the quintiles of the orthostatic SBP changes , showed a J-shaped relationship in untreated hypertensive patients , as was also the case for LVH in hypertensive women . CONCLUSIONS OH is associated with CV risk ; the associations of OHT with TOD and stroke in hypertensive patients still need to be confirmed in prospect i ve studies BACKGROUND The presence of orthostatic hypotension ( OH ) predicts all-cause mortality and incident cardiovascular disease . Whether or not OH is associated with the development of  heart failure ( HF )  remains unknown . METHODS In this Swedish population -based prospect i ve study ( the Malmö Preventive Project ) , the incidence of HF in relation to baseline OH , defined as decrease in systolic ( SBP ) ≥20 mm Hg and /or diastolic blood pressure ( DBP ) ≥10 mm Hg upon st and ing , was studied in 32,669 middle-aged individuals ( 68.2 % men ; mean age , 45.6 ± 7.4 years ) over a mean follow-up period of 24 years . RESULTS At baseline , 1,991 ( 6.1 % ) participants were found to have OH . During follow-up , 1,293 persons ( 4.0 % , mean age at presentation : 67.9 ± 7.9 years ) were hospitalized for HF , 912 ( 2.8 % ) of whom without previous or concurrent myocardial infa rct ion ( MI ) ( " nonischemic HF " ) . Among those who had OH , the corresponding numbers were 6.5 % ( n = 129 ) and 4.6 % ( n = 92 ) , respectively . In multivariable Cox proportional hazard models , taking conventional HF risk factors into account , OH was associated with both all-cause and " nonischemic " HF events ( hazard ratio ( HR ) : 1.22 , 1.01 - 1.46 , and 1.31 , 1.05 - 1.63 , respectively ) . The association between OH and HF was more pronounced in younger ( aged < 45 years ) than older individuals ( 2.05 ; 1.31 - 3.22 vs. 1.12 , 0.92 - 1.38 , respectively , P < 0.001 for interaction between age and OH on incident HF ) . CONCLUSIONS The presence of OH among middle-aged adults  predicts long-term incidence of HF hospitalizations independently of conventional risk factors . Our findings add to the available data indicating that OH is a potential independent cardiovascular risk factor , especially with regard to younger individuals and nonischemic HF BACKGROUND It is accepted that orthostatic hypotension is a clinical marker for the diagnosis of multiple system atrophy , but conflicting data indicate that it may also be present in Parkinson disease ( PD ) . OBJECTIVES To evaluate the prevalence of autonomic cardiovascular impairment and orthostatic hypotension in a large group of patients with de novo PD , followed up for at least 7 years , to clinical ly confirm the diagnosis of the disease . METHODS During a 2-year recruiting period , 60 untreated patients diagnosed as having idiopathic PD underwent autonomic cardiovascular function evaluation using the Ewing test . Patients subsequently received dopaminergic therapy and their condition was followed up for at least 7 years . RESULTS Nine ( 15 % ) of 60 patients were excluded from the study because during the follow-up period a parkinsonian syndrome was diagnosed ( 5 had multiple system atrophy and 4 had progressive supranuclear palsy ) . Data from 51 patients with PD underwent final statistical analysis and the results were compared with those of 51 age-matched healthy control subjects who had taken the same battery of autonomic tests . A statistically significant difference was found in postural hypotension ( P = .02 ) and deep breathing test results ( P = .03 ) between patients and controls . Seven ( 14 % ) of 51 patients with PD and 3 ( 60 % ) of 5 patients with multiple system atrophy had a decrease of more than 20 mm Hg in systolic blood pressure on st and ing . CONCLUSIONS Data from this study indicate a high prevalence of sympathetic and parasympathetic failure in patients with de novo PD , and when using a decrease of at least 20 mm Hg in systolic blood pressure , manometric orthostatic hypotension was found in 7 ( 14 % ) of the 51 patients with de novo PD Objective : To study the therapeutic effect and mechanism of action of 3,4-DL-threo-dihydroxyphenylserine ( DL-DOPS ) in neurogenic orthostatic hypotension . Methods : The blood pressure ( BP ) response to an orthostatic challenge on DL-DOPS was compared with that of placebo in a r and omized , double-blind , placebo-controlled , crossover trial in 10 patients . The mechanism of action of DOPS was studied by measuring forearm vascular resistance and changes in supine and upright plasma DL-DOPS and norepinephrine levels . The effect of DL-DOPS on the quality of life was determined by question naire . Results : DL-DOPS increased the supine ( p < 0.001 ) and upright ( p < 0.05 ) systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) ( both p < 0.01 ) . The peak SBP on DL-DOPS in the supine position occurred 300 minutes after ingestion of the medication . The increase in BP was accompanied by an increase in plasma levels of norepinephrine and DL-DOPS  in both the supine and upright positions after DL-DOPS ingestion ( p < 0.0001 ) . There was a trend toward improvement in symptoms of orthostatic intolerance . Conclusion : DL-DOPS improved features of neurogenic orthostatic hypotension in patients with central and peripheral autonomic nervous system disease . There was an increase in plasma norepinephrine . No major side effects occurred OBJECTIVES To investigate the relationships between uncontrolled and controlled hypertension , orthostatic hypotension ( OH ) , and falls in participants of the Maintenance of Balance , Independent Living , Intellect , and Zest in the Elderly of Boston Study ( N=722 , mean age 78.1 ) . DESIGN Prospect i ve population -based study . SETTING Community . PARTICIPANTS Seven hundred twenty-two adults aged 70 and older living within a 5-mile radius of the study headquarters at Hebrew Rehabilitation Center in Boston .  MEASUREMENTS Blood pressure ( BP ) was measured at baseline in the supine position and after 1 and 3 minutes of st and ing .  Systolic OH ( SOH ) and diastolic OH at 1 and 3 minutes were defined as a 20-mmHg decline in systolic BP and a 10-mmHg decline in diastolic BP upon st and ing . Hypertension was defined as BP of 140/90 mmHg or greater or receiving antihypertensive medications ( controlled if BP < 140/90 mmHg and uncontrolled if ≥ 140/90 mmHg ) . Falls data were prospect ively collected using monthly calendars . Fallers were defined as those with at least two falls within 1 year of follow-up . RESULTS OH was highest in participants with uncontrolled hypertension ; SOH at 1 minute was 19 % in participants with uncontrolled hypertension , 5 % in those with controlled hypertension , and 2 % in those without hypertension ( P ≤ .001 ) ) . Participants with SOH at 1 minute and uncontrolled hypertension were at greater risk of falls ( hazard ratio=2.5 , 95 % confidence interval = 1.3 - 5.0 ) than those with uncontrolled hypertension without OH . OH by itself was not associated with falls . CONCLUSION Older adults with uncontrolled hypertension and SOH at 1 minute are at greater risk for falling within 1 year . Hypertension control , with or without OH , is not associated with greater risk of falls in older community-dwelling adults BACKGROUND Vitamin D and calcium metabolism are involved in vascular smooth muscle cell proliferation , endothelial function and blood pressure ( BP ) regulation . Their physiopathology has been a matter of intensive clinical investigation with variable and sometimes contradictory results . Vitamin D insufficiency is highly prevalent in the general population , particularly among the elderly . We evaluated the association between serum 25(OH)-D levels and arterial BP in this population . METHODS An epidemiological cross-sectional study was design ed to analyse the prevalence of hypovitaminosis D ( ' D'AVIS ' study ) in our reference area . The study was performed on a representative r and om sample of the population over 64 years of age obtained from five primary health care areas . A medical record , arterial BP and biological analysis : serum 25(OH)-D , iPTH , creatinine , urea , calcium , albumin were obtained . RESULTS A total of 237 subjects ( 53 % women ) , aged between 64 and 93 ( mean 71.7 + /- 5.3 ) , were evaluated . The mean serum 25(OH)-D levels were 17.21 + /- 7.57 ng/ml ( interval 5 - 54 ; 86 % had < 25 ng/ml ) . The mean BP was 138.8 + /- 14/80 + /- 7.4 mmHg , and 46 % were on antihypertensive treatment . A significant negative association was observed between serum 25(OH)-D levels and systolic ( r = -0.153 , P = 0.018 ) and diastolic BP ( r = -0.152 , P = 0.019 ) . This association persisted after controlling for possible confounders in the multivariate analyses . CONCLUSIONS Low serum 25(OH)-D levels were inversely and independently associated with BP . Supplemental measures to prevent hypovitaminosis D in this population would be important , not only to protect the skeletal system but also for the possible beneficial effects on the cardiovascular system and the BP regulation Abstract —We evaluated whether droxidopa , a prodrug converted to norepinephrine , is beneficial in the treatment of symptomatic neurogenic orthostatic hypotension , which results from failure to generate an appropriate norepinephrine response to postural challenge . Patients with symptomatic neurogenic orthostatic hypotension and Parkinson disease , multiple system atrophy , pure autonomic failure , or nondiabetic autonomic neuropathy underwent open-label droxidopa titration ( 100–600 mg , 3 × daily ) . Responders then received an additional 7-day open-label treatment at their individualized dose . Patients were subsequently r and omized to continue with droxidopa or withdraw to placebo for 14 days . We then assessed patient-reported scores on the Orthostatic Hypotension Question naire and blood pressure measurements . Mean worsening of Orthostatic Hypotension Question naire dizziness/lightheadedness score from r and omization to end of study ( the primary outcome ; N=101 ) was 1.9±3.2 with placebo and 1.3±2.8 units with droxidopa ( P=0.509 ) . Four of the other 5 Orthostatic Hypotension Question naire symptom scores and all 4 symptom-impact scores  favored droxidopa , with statistical significance for the patient ’s self-reported ability to perform activities requiring st and ing a short time ( P=0.033 ) and st and ing a long time ( P=0.028 ) . Furthermore , a post hoc analysis of a predefined composite score of all symptoms ( Orthostatic Hypotension Question naire composite ) demonstrated a significant benefit for droxidopa ( P=0.013 ) . There was no significant difference between groups for st and ing systolic blood pressure ( P=0.680 ) . Droxidopa was well tolerated . In summary , this r and omized withdrawal droxidopa study failed to meet its primary efficacy end point . Additional clinical trials are needed to confirm that droxidopa is beneficial in symptomatic neurogenic orthostatic hypotension , as suggested by the positive secondary outcomes of this trial . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00633880
CONCLUSION Our meta- analysis highlights that hypovitaminosis D is associated with orthostatic hypotension , independent of potential confounders .
OBJECTIVES Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes .
Recently , interest has developed in hypovitaminosis D ( defined as low 25 hydroxiyvitamin D levels ) as a potential risk factor for orthostatic hypotension .
We conducted a systematic review and meta- analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D , including the adjustment of potential confounders ( age , sex , BMI , renal function , comorbidities , seasonality , use of antihypertensive medications , and supplementation with cholecalciferol ) .