Predictors of Orthostatic Hypotension in the Elderly: Results from the Amirkola Health and Ageing Project (AHAP) Study

  • Mehdi Safarpour Department of Disease Prevention and Control, Health Deputy, Babol University of Medical Sciences, Babol, Iran.
  • Akbar Fotouhi Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Reza Hosseini Mail Department of Community Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
  • Masume Mohamadzade Department of Disease Prevention and Control, Health Deputy, Babol University of Medical Sciences, Babol, Iran.
  • Ali Bijani Children’s Non-Communicable Diseases Research Center, Babol University of Medical Sciences, Babol, Iran.
Hypotension; orthostatic, Aged, Prevalence


Background: Orthostatic hypotension (OH) in the elderly is an important health challenge that poses a significant burden. We sought to determine the prevalence and correlates of OH in an elderly population-based study.
Methods: This study was conducted within the framework of the Amirkola Health and Ageing Project (AHAP) on 1,588 elderly individuals aged ≥60 years. The baseline measurement was performed from April 2011 to July 2012. The relationships between OH (dependent variable) and age, sex, diabetes, hypertension, and cognitive status (independent variables) were investigated by logistic regression.
Results: The mean age of the participants was 69.37±7.42 years (men: 69.96±7.68 y, women: 68.66±7.02 y). The prevalence of OH was 10.7%: 8.4% in the male and 13.7% in the female patients. In the final model, hypertension (OR=2.4, 95% CI: 1.6–3.7), diabetes (OR=1.3, 95% CI: 1.0–1.9), age (OR=2.9, 95% CI: 1.7–4.8), and female sex (female [OR=1.6, 95% CI: 1.1–2.3]) were significantly correlated with OH.
Conclusion: The prevalence of OH in our elderly subjects increased with age. Additionally, the older participants with diabetes and hypertension had a higher likelihood of having this OH.


Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clinical Autonomic Research. 1996;6(2):125-6.

Winkler A, Bosman D. Symptomatic postural hypotension in diabetes: aetiology and management. Practical Diabetes. 2003;20(6):219-25.

Purewal T, Watkins P. Postural hypotension in diabetic autonomic neuropathy: a review. Diabetic medicine. 1995;12(3):192-200.

Lipsitz LA. Orthostatic hypotension in the elderly. The New England journal of medicine. 1989;321(14):952-7.

Hines S, Houston M, Robertson D. The clinical spectrum of autonomic dysfunction. The American Journal of Medicine. 1981;70(5):1091-6.

Khurana RK. Coat-hanger ache in orthostatic hypotension. Cephalalgia. 2012;32(10):731-7. 7. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Consequences of orthostatic blood pressure variability in middle-aged men (The Malmö Preventive Project). Journal of Hypertension. 2010;28(3):551-9. 8. Low PA. Prevalence of orthostatic hypotension. Clinical Autonomic Research. 2008;18(1):8-13.

Masaki KH, Schatz IJ, Burchfiel CM, Sharp DS, Chiu D, Foley D, et al. Orthostatic hypotension predicts mortality in elderly men. Circulation. 1998;98(21):2290-5.

Joseph A, Wanono R, Flamant M, Vidal-Petiot E. Orthostatic hypotension: A review. Néphrologie & Thérapeutique. 2017;13:S55-S67.

van Hateren KJ, Kleefstra N, Blanker MH, Ubink-Veltmaat LJ, Groenier KH, Houweling ST, et al. Orthostatic hypotension, diabetes, and falling in older patients: a cross-sectional study. Br J Gen Pract. 2012;62(603):e696-e702.

Bouhanick B, Meliani S, Doucet J, Bauduceau B, Verny C, Chamontin B, et al., editors. Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion. Annales de Cardiologie et d'Angéiologie; 2014: Elsevier.

Wu J-S, Yang Y-C, Lu F-H, Wu C-H, Wang R-H, Chang C-J. Population-based study on the prevalence and risk factors of orthostatic hypotension in subjects with pre-diabetes and diabetes. Diabetes Care. 2009;32(1):69-74.

Tsutsu N, Nunoi K, Yokomizo Y, Kikuchi M, Fujishima M. Relationship between glycemic control and orthostatic hypotension in type 2 diabetes mellitus—a survey by the Fukuoka Diabetes Clinic Group. Diabetes research and clinical practice. 1990;8(2):115-23.

Ooi WL, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. The American journal of medicine. 2000;108(2):106-11.

Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR. Orthostatic Hypotension-Related Hospitalizations in the United States. The American Journal of Medicine. 2007;120(11):975-80.

Hosseini SR, Cumming RG, Kheirkhah F, Nooreddini H, Baiani M, Mikaniki E, et al. Cohort profile: The Amirkola health and ageing project (AHAP). International journal of epidemiology. 2013;43(5):1393-400.

Ong HL, Abdin E, Seow E, Pang S, Sagayadevan V, Chang S, et al. Prevalence and Associative Factors of Orthostatic Hypotension in Older Adults: Results from the Well-being of the Singapore Elderly (WiSE) study. Archives of Gerontology and Geriatrics. 2017.

Finucane C, O'Connell MD, Fan CW, Savva GM, Soraghan CJ, Nolan H, et al. Age related normative changes in phasic orthostatic blood pressure in a large population study: findings from the Irish Longitudinal Study on Ageing (TILDA). Circulation. 2014:CIRCULATIONAHA. 114.009831.

Gangavati A, Hajjar I, Quach L, Jones RN, Kiely DK, Gagnon P, et al. Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community‐Dwelling Elderly Population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study. Journal of the American Geriatrics Society. 2011;59(3):383-9.

Zhu QO, Tan CSG, Tan HL, Wong RG, Joshi CS, Cuttilan RA, et al. Orthostatic hypotension: prevalence and associated risk factors among the ambulatory elderly in an Asian population. Singapore medical journal. 2016;57(8):444.

Budyono C, Setiati S, Purnamasari D, Rumende CM. The Proportion of Orthostatic Hypotension and Its Relationship with HbA1c Levels in Elderly Patients with Diabetes. Acta Medica Indonesiana. 2016;48(2):122-8.

Angelousi A, Girerd N, Benetos A, Frimat L, Gautier S, Weryha G, 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. Journal of hypertension. 2014;32(8):1562-71.

Arbab-Zadeh A, Dijk E, Prasad A, Fu Q, Torres P, Zhang R, et al. Effect of aging and physical activity on left ventricular compliance. Circulation. 2004;110(13):1799-805.

Ray CA, Monahan KD. Aging attenuates the vestibulosympathetic reflex in humans. Circulation. 2002;105(8):956-61.

James MA, Potter JF. Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects. Age and ageing. 1999;28(6):522-30.

Cheng Y-C, Vyas A, Perlmuter LC, Hymen E. Gender differences in orthostatic hypotension. The American journal of the medical sciences. 2011;342(3):221-5.

Fedorowski A, Burri P, Melander O. Orthostatic hypotension in genetically related hypertensive and normotensive individuals. Journal of hypertension. 2009;27(5):976-82.

Evans JM, Ziegler MG, Patwardhan AR, Ott JB, Kim CS, Leonelli FM, et al. Gender differences in autonomic cardiovascular regulation: spectral, hormonal, and hemodynamic indexes. Journal of Applied Physiology. 2001;91(6):2611-8.

Ramaekers D, Ector H, Aubert A, Rubens A, Van de Werf F. Heart rate variability and heart rate in healthy volunteers. Is the female autonomic nervous system cardioprotective? European heart journal. 1998;19(9):1334-41.

Shoemaker JK, Hogeman CS, Khan M, Kimmerly DS, Sinoway LI. Gender affects sympathetic and hemodynamic response to postural stress. American Journal of Physiology-Heart and Circulatory Physiology. 2001;281(5):H2028-H35.

Watt GC, Harrap SB, Foy CJ, Holton DW, Edwards HV, Davidson HR, et al. Abnormalities of glucocorticoid metabolism and the renin-angiotensin system: a four-corners approach to the identification of genetic determinants of blood pressure. Journal of hypertension. 1992;10(5):473-82.

Summers RL, Platts S, Myers JG, Coleman TG. Theoretical analysis of the mechanisms of a gender differentiation in the propensity for orthostatic intolerance after spaceflight. Theoretical Biology and Medical Modelling. 2010;7(1):8.

Yates B, Kerman I. Post-spaceflight orthostatic intolerance: possible relationship to microgravity-induced plasticity in the vestibular system. Brain research reviews. 1998;28(1):73-82.

Waters WW, Ziegler MG, Meck JV. Postspaceflight orthostatic hypotension occurs mostly in women and is predicted by low vascular resistance. Journal of Applied Physiology. 2002;92(2):586-94.

Harm DL, Jennings RT, Meck JV, Powell MR, Putcha L, Sams CP, et al. Invited review: gender issues related to spaceflight: a NASA perspective. Journal of Applied Physiology. 2001;91(5):2374-83.

Sambati L, Calandra-Buonaura G, Poda R, Guaraldi P, Cortelli P. Orthostatic hypotension and cognitive impairment: a dangerous association? Neurological Sciences. 2014;35(6):951-7.

Matsubayashi K, Okumiya K, Wada T, Osaki Y, Fujisawa M, Doi Y, et al. Postural dysregulation in systolic blood pressure is associated with worsened scoring on neurobehavioral function tests and leukoaraiosis in the older elderly living in a community. Stroke. 1997;28(11):2169-73.

Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G. Risk factors for vascular dementia: hypotension as a key point. Vascular health and risk management. 2008;4(2):395.

Mehrabian S, Duron E, Labouree F, Rollot F, Bune A, Traykov L, et al. Relationship between orthostatic hypotension and cognitive impairment in the elderly. Journal of the neurological sciences. 2010;299(1):45-8.

Bengtsson-Lindberg M, Larsson V, Minthon L, Wattmo C, Londos E. Lack of orthostatic symptoms in dementia patients with orthostatic hypotension. Clinical Autonomic Research. 2015;25(2):87-94.

Curreri C, Giantin V, Veronese N, Trevisan C, Sartori L, Musacchio E, et al. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly. Hypertension. 2016:HYPERTENSIONAHA. 116.07334.

Viramo P, Luukinen H, Koski K, Laippala P, Sulkava R, Kivelä SL. Orthostatic hypotension and cognitive decline in older people. Journal of the American Geriatrics Society. 1999;47(5):600-4.

Yap PLK, Niti M, Yap KB, Ng TP. Orthostatic hypotension, hypotension and cognitive status: early comorbid markers of primary dementia? Dementia and geriatric cognitive disorders. 2008;26(3):239.

Goldstein DS, Pechnik S, Holmes C, Eldadah B, Sharabi Y. Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension. 2003;42(2):136-42.

Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. The American journal of medicine. 2007;120(10):841-7.

Tsutsu N, Nunoi K, Yokomizo Y, Kikuchi M, Fujishima M. Relationship between glycemic control and orthostatic hypotension in type 2 diabetes mellitus--a survey by the Fukuoka Diabetes Clinic Group. Diabetes Res Clin Pract. 1990;8(2):115-23.

De Kanter M, Lilja B, Elmståhl S, Eriksson K-F, Sundkvist G. A prospective study of orthostatic blood pressure in diabetic patients. Clinical Autonomic Research. 1998;8(4):189-93.

How to Cite
Safarpour M, Fotouhi A, Hosseini SR, Mohamadzade M, Bijani A. Predictors of Orthostatic Hypotension in the Elderly: Results from the Amirkola Health and Ageing Project (AHAP) Study. J Tehran Heart Cent. 14(4):165-170.
Original Article(s)