Orthostatic Hypotension and Cardiac Changes After Long-Term Follow-Up

Background: Orthostatic hypotension (OH) increases the risk of incident cardiovascular disease (CVD) and all-cause mortality in population-based cohort studies. Whether OH is associated with development of cardiac anomalies has not been sufficiently explored.

Methods: In the prospective population-based Malmö Preventive Project (MPP), a subset of 974 non-diabetic individuals (mean age: 67 years; 29% women) were examined with echocardiography after a mean follow-up period of 23±4 years from baseline. The association of increased left ventricular mass (LVM), pathological cardiac chamber volumes, echocardiographic parameters of systolic and diastolic dysfunction in relation to the presence of OH at baseline, defined as decrease in systolic ≥20mm Hg and/or diastolic blood pressure (BP) ≥10mm Hg upon standing, was studied.

Results: Among reexamined MPP participants, 40 (4.1%) met OH criteria during baseline screening. In the multivariable-adjusted Cox proportional hazard models, taking demographics, BP, and antihypertensive treatment (AHT) into account, OH predicted left ventricular hypertrophy (LVH) (hazard ratio (HR): 1.97, 1.01-3.84; P = 0.047), decreased right chamber volume (HR: 1.74, 1.19-2.57; P = 0.005), and reduced early diastolic tissue velocity in septal wall (HR: 1.47, 1.01-2.14; P = 0.045). No significant associations were seen between OH and atrial chamber volumes, LV volume, and LV systolic function.

Conclusions: The presence of OH among middle-aged adults is associated with the development of structural cardiac changes such as LVH and declining right chamber volume, as well as with the development of diastolic dysfunction, independently of traditional risk factors. These findings may contribute to the understanding of how prevalent OH impacts the risk of CVD.