Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Jan 1;75(1):117-122.
doi: 10.1093/gerona/gly188.

The Prevalence of Orthostatic Hypotension: A Systematic Review and Meta-Analysis

Nor I'zzati Saedon  1 , Maw Pin Tan  1 , James Frith  2   3
Affiliations
Meta-Analysis

The Prevalence of Orthostatic Hypotension: A Systematic Review and Meta-Analysis

Nor I'zzati Saedon et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to be common in older people, estimates of its prevalence vary widely. This study aims to address this by pooling the results of epidemiological studies.

Methods: MEDLINE, EMBASE, PubMed, Web of Science, and ProQuest were searched. Studies were included if participants were more than 60 years, were set within the community or within long-term care and diagnosis was based on a postural drop in systolic blood pressure (BP) ≥20 mmHg or diastolic BP ≥10 mmHg. Data were extracted independently by two reviewers. Random and quality effects models were used for pooled analysis.

Results: Of 23,090 identified records, 20 studies were included for community-dwelling older people (n = 24,967) and six were included for older people in long-term settings (n = 2,694). There was substantial variation in methods used to identify OH with differing supine rest duration, frequency and timing of standing BP, measurement device, use of standing and tilt-tables and interpretation of the diagnostic drop in BP. The pooled prevalence of OH in community-dwelling older people was 22.2% (95% CI = 17, 28) and 23.9% (95% CI = 18.2, 30.1) in long-term settings. There was significant heterogeneity in both pooled results (I2 > 90%).

Conclusions: OH is very common, affecting one in five community-dwelling older people and almost one in four older people in long-term care. There is great variability in methods used to identify OH.

Keywords: Epidemiology; Postural hypotension; Syncope.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study screening and selection.
Figure 2.
Figure 2.
The prevalence of OH in community-dwelling older people. The highest prevalence rates (Cooke et al. (5), Kerr (27)) are seen in studies using continuous BP monitoring.
Figure 3.
Figure 3.
The prevalence of OH in long-term care.
Figure 4.
Figure 4.
Meta-regression bubble graph demonstrating the relationship between the age of the included cohorts and the prevalence of OH. Slope coefficient (s.e.) = 0.012 (0.01), p = 0.264. The area of each circle is inversely proportional to the variance of the log-prevalence. The superimposed line is obtained by inverse variance heterogeneity weighted regression. The plot depicts the estimated prevalence of orthostatic hypotension in included studies according to the mean age of sample populations in years.
See this image and copyright information in PMC

References

    1. Freeman R, Wieling W, Axelrod FB, et al. . Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21:69–72. doi: 10.1007/s10286-011-0119-5 - PubMed
    1. Low PA, Opfer-Gehrking TL, McPhee BR, et al. . Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995;70:617–622. doi: 10.1016/S0025-6196(11)63911-6 - PubMed
    1. Angelousi A, Girerd N, Benetos A, et al. . Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertens. 2014;32:1562–1571; discussion 1571. doi: 10.1097/HJH.0000000000000235 - PubMed
    1. Ricci F, Fedorowski A, Radico F, et al. . Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36:1609–1617. doi: 10.1093/eurheartj/ehv093 - PubMed
    1. Cooke J, Carew S, Quinn C, et al. . The prevalence and pathological correlates of orthostatic hypotension and its subtypes when measured using beat-to-beat technology in a sample of older adults living in the community. Age Ageing. 2013;42:709–714. doi: 10.1093/ageing/aft112 - PubMed

Publication types