Clinical implications of delayed orthostatic hypotension: A 10-year follow-up study

Abstract

Objective: To define the long-term outcome of delayed orthostatic hypotension (OH).

Hypothesis: Delayed OH is an early and milder form of OH that progresses over time.

Methods: We reviewed the medical records of 230 previously reported patients who completed autonomic testing at our center from January 1, 2002, through December 31, 2003. All available information on clinical diagnosis, mortality, medication use, and autonomic testing were extracted and included in the reported outcomes. Standard criteria were used to define OH and delayed OH.

Results: Forty-eight individuals with delayed OH, 42 individuals with OH, and 75 controls had complete follow-up data. Fifty-four percent of individuals with delayed OH progressed to OH. Thirty-one percent of individuals with delayed OH developed an α-synucleinopathy. The 10-year mortality rate in individuals with delayed OH was 29%, in individuals with baseline OH was 64%, and in controls was 9%. The 10-year mortality of individuals who progressed to OH was 50%. Progression to OH was associated with developing an α-synucleinopathy, baseline diabetes, and abnormal baseline autonomic test results.

Conclusion: Delayed OH frequently progresses to OH with a high associated mortality.

Figure 1. Study participants

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) diagram of the participants involved in this study.

Figure 2. Summary of outcomes

Report of mortality by initial and 10-year follow-up diagnosis of the individuals included in the study. The orange boxes represent the original diagnosis of those individuals tested in 2002–2003. Many individuals did not have a diagnosis at that time. During 10 years of follow-up, they were diagnosed with a number of different disorders. The yellow boxes represent the individuals alive after 10 years of follow up subdivided by orthostatic hypotension group (the delayed orthostatic hypotension group is subdivided into those who progressed to orthostatic hypotension and those who continued to have delayed orthostatic hypotension). The green boxes at the bottom describe the individuals who died over the 10 years of follow-up, by orthostatic hypotension group. OH = orthostatic hypotension. *Other diseases include depression, hypertension, thyroid dysfunction, dyslipidemia, and irritable bowel disease.

Figure 3. Kaplan-Meier survival curve

Mortality rates over time are reported for individuals with orthostatic hypotension (OH), individuals with delayed OH (DOH) (total, and identified by progression or no progression to OH), and controls.