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

Autor: Zahra Pasdar, Lorenzo De Paola, Ben Carter, Tiberiu A Pana, John F Potter, Phyo K Myint
Rok vydání: 2023
Předmět:
Zdroj: European Journal of Preventive Cardiology.
ISSN: 2047-4881
2047-4873
DOI: 10.1093/eurjpc/zwad158
Popis: Introduction 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 Study inclusion criteria included: (i) any observational/interventional studies of participants aged ≥18 years (ii) which 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-19th 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 (HR/OR), with 95% confidence interval. Results Twenty studies (n = 61669; 47.3% women) were eligible, of which thirteen were included in the meta-analysis (n = 55456; 47.3% women). Median (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 2 studies (HR:1.39, 1.05-1.84) and near doubled odds of stroke/cerebrovascular disease (OR:1.94, 1.52-2.48). Lack of association with other outcomes may be due to weak evidence or low statistical power. Conclusions 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.
Databáze: OpenAIRE
Externí odkaz: