Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Respiratory Department, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
Cardiology Department, Beijing Liangxiang Hospital, Capital Medical University, Beijing, China
Department of Statistics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan, China
Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
This research was supported in part by the Beijing Health System High Level Health Technology Talent Cultivation Plan—2015-3-028, Beijing Chaoyang 1351 Talent Cultiva?tion Plan—CYXX-2017-03, National Natural Science Foun?dation of China—81200194, 81770253, Beijing Municipal Natural Science Foundation—7122072, National Major Research Plan Training Program of China—91849111.
Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events, the underlying mechanisms are still controversial. The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old. Methods This is a prospective observational cohort study. One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled. Participants were grouped according to whether they had a drop > 20 mmHg in systolic or > 10 mmHg in diastolic BP (orthostatic hypotension), an increase in mean orthostatic systolic blood pressure > 20 mm Hg (orthostatic hypertension), or normal changes within 3 min of orthostatism. Multiple regression modeling was used to investigate the relationship between orthostatic hypotension, orthostatic hypertension and subclinical organ damage with adjustment for confounders. Results Orthostatic hypotension and orthostatic hypertension were found in 461 (23.1%) and 189 (9.5%) participants, respec?tively. Measurement of carotid intima-media thickness (IMT), brachial-ankle pulse wave velocity (baPWV), clearance of creatinine, and microalbuminuria were associated with orthostatic hypotension; measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model. After adjustment, IMT [odds ratio (OR), 95% confidence interval (CI) per one-SD increment: 1.385, 1.052-1.823; P = 0.02], baPWV (OR: 1.627, 95% CI: 1.041-2.544; P = 0.033) and microalbuminuria (OR: 1.401, 95% CI: 1.002-1.958; P = 0.049) were still associated with orthostatic hypotension, while orthostatic hypertension was only associated with IMT (OR: 1.730, 95%CI: 1.143-2.618; P = 0.009). Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis, arterial stiffness and renal damage in subjects over 60 years old. Orthostatic hypertension correlates with carotid atherosclerosis only.