Orthostatic hypertension and major adverse events: a systematic review and meta-analysis

Pasdar, Zahra, De Paola, Lorenzo, Carter, Ben, Pana, Tiberiu A., Potter, John F. and Myint, Phyo K. (2023) Orthostatic hypertension and major adverse events: a systematic review and meta-analysis. European Journal of Preventive Cardiology, 30 (10). 1028–1038. ISSN 2047-4873

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Aims: The role of orthostatic hypertension (OHT) in cardiovascular disease (CVD) and mortality is unclear. We aimed to determine if this association exists through a systematic review and meta-analysis. Methods and results: Study inclusion criteria included: (i) any observational/interventional studies of participants aged ≥18 years (ii) that assessed the relationship between OHT and (iii) at least one outcome measure—all-cause mortality (primary outcome), coronary heart disease, heart failure, stroke/cerebrovascular disease, or neurocognitive decline. MEDLINE, EMBASE, Cochrane, clinicaltrials.gov, and PubMed were independently searched by two reviewers (inception—19 April 2022). Critical appraisals were conducted using the Newcastle–Ottawa Scale. Random-effects meta-analysis was performed using a generic inverse variance method, and narrative synthesis or pooled results were presented as an odds or hazards ratio (OR/HR), with 95% confidence interval. Twenty studies (n = 61 669; 47.3% women) were eligible, of which 13 were included in the meta-analysis (n = 55 456; 47.3% women). Median interquartile range (IQR) follow-up for prospective studies was 7.85 (4.12, 10.83) years. Eleven studies were of good quality, eight fair, and one poor. Relative to orthostatic normotension (ONT), systolic OHT (SOHT) was associated with a significant 21% greater risk of all-cause mortality (HR: 1.21, 1.05–1.40), 39% increased risk of CVD mortality based on two studies (HR: 1.39, 1.05–1.84), and near doubled odds of stroke/cerebrovascular disease (OR: 1.94, 1.52–2.48). The lack of association with other outcomes may be due to weak evidence or low statistical power. Conclusion: Patients with SOHT may have higher mortality risk relative to those with ONT and increased odds of stroke/cerebrovascular disease. Whether interventions can reduce OHT and improve outcomes should be explored.

Item Type: Article
Additional Information: Funding information: No specific funding. This paper represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care (BC). Data availability: The data underlying this article are available as part of the online supplementary material.
Uncontrolled Keywords: cardiovascular disease,meta-analysis,mortality,orthostatic hypertension,systematic review,cardiology and cardiovascular medicine,epidemiology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine
Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 14 Jun 2023 14:15
Last Modified: 29 Aug 2023 09:30
URI: https://ueaeprints.uea.ac.uk/id/eprint/92382
DOI: 10.1093/eurjpc/zwad158


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