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 Malmo Preventive Project (MPP), a subset of 974 non-diabetic individuals (mean age: 67 years; 29% women) were examined with echocardiography after a mean followup 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 >= 20 mm Hg and/or diastolic blood pressure (BP) >= 10 mm 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.