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(Stroke. 2000;31:2307.)
© 2000 American Heart Association, Inc.
Original Contributions |
Orthostatic Hypotension as a Risk Factor for Stroke
The Atherosclerosis Risk in Communities (ARIC) Study, 1987–1996
From the Departments of Epidemiology (M.L.E., K.M.R.) and Biostatistics (D.J.C.), School of Public Health, University of North Carolina, Chapel Hill; Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (D.K.A.); Mississippi Family Health Center, Jackson (R.S.); and Division of Hypertension, University of Mississippi Medical Center, Jackson (D.J.).
Background and Purpose—The association between orthostatic hypotension (OH) and stroke has rarely been investigated in longitudinal studies. The purpose of the present study was to determine whether OH predicts ischemic stroke in a middle-aged, biethnic population after adjustment for known stroke risk factors. Diastolic, systolic, and consensus OH were evaluated for baseline associations and for the ability to predict stroke.
Methods—In 11 707 persons from the
Atherosclerosis Risk in Communities (ARIC) cohort who
were free of stroke and overt heart disease at baseline, Cox
proportional hazards analyses modeled the association between
OH at baseline and incident ischemic stroke over 7.9 years of
follow-up. OH was defined as a systolic blood pressure drop
20 mm Hg (systolic OH), a diastolic blood
pressure drop 10 mm Hg (diastolic OH), or a drop in
either (consensus OH) when a person changed from a supine to standing
position.
Results—OH was predictive of ischemic stroke, even after adjustment for numerous stroke risk factors (consensus OH: hazard ratio, 2.0; 95% CI, 1.2 to 3.2). While the baseline characteristics associated with OH varied depending on the type of OH, all types of OH had a similar risk of stroke.
Conclusions—OH is an easily obtained measurement that may help to identify middle-aged persons at risk for stroke.
Key Words: cerebral infarction • epidemiology • hypotension, orthostatic • prospective studies
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