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Associations of the systolic and diastolic components of orthostatic hypotension with markers of cardiovascular risk in older men: A cross-sectional analysis from The British Regional Heart Study

Lookup NU author(s): Professor Sheena Ramsay



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC. The mechanisms underlying the association between orthostatic hypotension (OH) and cardiovascular disease are unclear. We investigated whether OH is associated with circulating cardiovascular risk markers. This was a cross-sectional analysis of 3857 older, community-dwelling men. “Consensus OH” was defined as a sitting-to-standing decrease in systolic blood pressure ≥20 mm Hg and/or diastolic blood pressure ≥10 mm Hg that occurred within three minutes of standing. Multiple generalized linear regression and logistic models were used to examine the association between cardiovascular risk markers and OH. Consensus OH was present in 20.2%, consisting of isolated systolic OH in 12.6%, isolated diastolic OH in 4.6%, and combined systolic and diastolic OH in 3.0%. Concentration of von Willebrand factor, a marker of endothelial dysfunction, was positively associated with isolated systolic OH (OR 1.35, 95% CI 1.05-1.73) and combined systolic and diastolic OH (OR 2.27, 95% CI 1.35-3.83); high circulating phosphate concentration, which may reflect vascular calcification, was associated with isolated diastolic OH (OR 1.53, 95% CI 1.04-2.25) and combined systolic and diastolic OH (OR 2.12, 95% CI 1.31-3.44), high-sensitivity troponin T, a marker of myocardial injury, was positively associated with isolated diastolic OH (OR 1.69, 95% CI 1.07-2.65) and N-terminal pro-brain natriuretic peptide, a marker of cardiac stress, was positively associated with combined systolic and diastolic OH (OR 2.14, 95% CI 1.14-4.03). In conclusion, OH is associated with some cardiovascular risk markers implicated in endothelial dysfunction, vascular calcification, myocardial injury, and cardiac stress. Clinicians should consider assessing cardiovascular risk in patients with OH.

Publication metadata

Author(s): Gilani A, Ramsay SE, Juraschek SP, Papacosta O, Lennon LT, Whincup PH, Wannamethee SG

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Hypertension

Year: 2020

Volume: 22

Issue: 10

Pages: 1892-1901

Print publication date: 01/10/2020

Online publication date: 16/08/2020

Acceptance date: 28/06/2020

Date deposited: 15/10/2020

ISSN (print): 1524-6175

ISSN (electronic): 1751-7176

Publisher: Wiley Periodicals, Inc.


DOI: 10.1111/jch.13996


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Funder referenceFunder name
British Heart Foundation. Grant Number: RG/13/16/30528
National Heart, Lung, and Blood Institute
National Institute for Health Research (NIHR) School for Primary Care Research