Orthostatic hypotension does not increase cardiovascular risk in the elderly at a population level.

background The general belief that orthostatic hypotension (OH) predisposes to cardiovascular events is based on sparse and contradictory data, rarely derived from population studies. methods A total of 1,016 men and women aged 6565\ua0 years was studied in a 12-year epidemiological population-based study. Cardiovascular events were detected in subjects with and without OH (blood pressure (BP) decrease 6520 mm Hg for systolic or 6510 mm Hg for diastolic), and Cox analysis was performed including OH as an independent variable. results In univariate analysis, coronary (20.2% vs. 13.1%, P\ua0=\ua00.05), cerebrovascular (13.1% vs. 8.4%, P\ua0=\ua00.05), and heart failure (HF) events (20.2% vs. 13.8%, P\ua0=\ua00.03) were apparently more incidental in subjects with OH than in those without OH. Nevertheless, after adjusting for age, gender, and systolic BP as confounders, OH did not act as a cardiovascular predictor (relative risk for cerebrovascular events 1.33, 95% confidence interval (CI), 0.78\u20132.2, for coronary events 1.25, CI 0.82\u20131.88, for HF 1.07, CI 0.71\u20131.62, for arrhythmias 0.82, CI 0.40\u20131.37, and for syncope 0.58, CI 0.13\u20132.71). conclusions Although OH seems to be a predictor of coronary, cerebrovascular, and HF events, no predictive role was found in models that include biological confounders. Independent of the cause of OH, age and systolic BP, which are positively associated with OH, fully explain the greater incidence of cardiovascular events and the greater cardiovascular risk observed in subjects with OH