Epidemiology

The prevalence of OH is greater in older people, but varies widely depending on the underlying medical condition.

Systematic reviews suggest OH prevalence of 19% to 22% in community-dwelling adults.[7][8]​ US population-based studies reported OH in less than 5% of people aged ≤54 years, approximately 14% of those aged 65 to 69 years, and in 20% or more of those aged ≥80 years.[9][10][11]​ Prevalence increases considerably among older people in nursing homes (31% to 37%) or geriatric wards (68%).[7][12][13][14]

The high prevalence among institutionalised patients probably reflects the presence of multiple risk factors in this population, such as neurodegenerative diseases that cause OH, the use of medications that may impair a proper response to postural changes (e.g., antihypertensives, antidepressants), and physical inactivity leading to deconditioning.

OH is an independent risk factor for mortality and cardiovascular comorbidities linked to increased hospital admissions. A number of studies have found that sufferers had a higher risk of developing heart failure, atrial fibrillation, coronary heart disease, myocardial infarction, and ischaemic stroke. Therefore, it may be a significant yet under-recognised risk factor for cardiovascular disease-related morbidity and mortality, especially among older adults.[15]

It is also associated with a number of non-cardiovascular adverse outcomes, including falls, fractures, syncope, cognitive decline or dementia, depression, frailty, and early death. Whether OH is a causal factor in the development of these adverse outcomes is a focus of ongoing debate. It is thought that hypoperfusion of skeletal muscle, heart, and brain may cause progressive organ injury. However, emerging evidence also suggests a role for comorbid hypertension in the supine or seated positions as the primary driver of injury and adverse outcomes.[16][17]​ It is equally possible that the combination of high and low blood pressure, that is, blood pressure variability, may drive clinical events.[15]

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