Orthostatic hypotension and cardiovascular risk: defining the epidemiological and prognostic relevance

An extremely large amount of evidence documents without any doubt that a chronic elevation in blood pressure values represents at any age a major independent risk factor for cerebrovascular, coronary, and also renal disease. 1–3 Evidence provided by a less consistent number of studies, however, has shown that also the opposite condition, i. e. a low blood pressure state, may indeed be associated with an increased cardiovascular risk. This is particularly the case for orthostatic hypotension, i. e. the clinical condition defined by international guidelines as that characterized by a blood pressure reduction during the first 3 min of assumption of the orthostatic position ≥20 mmHg for systolic and ≥10 mmHg for diastolic blood pressure, respectively. 4, 5 Indeed evidence has been provided that in patients with symptomatic and/or asymptomatic standing-related hypotension, without any evidence of co-existing conditions responsible for autonomic failure, the detection of this condition is associated with an increase in fatal and non-fatal cardiovascular events and also in all-cause mortality. 6–8 The evidence, however, has been largely provided in elderly people, and there is much less information available in younger individuals. 9, 10 Fedorowsky and co-workers have reported the results of a prospective study, 11 performed in the context of the Malmo Preventive Project, aimed at defining the prevalence, underlying causes, and prognostic value of orthostatic hypotension in a general Swedish population sample. The main features of the study can be summarized as follows. 11 First, the study followed … *Corresponding author. Tel: +39 039 233 357, Fax: +39 039 322 274, Email: giuseppe. manciaatunimib. it