{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:44:57Z","timestamp":1792633497255,"version":"4.5.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,5,15]]},"abstract":"\n Background<\/jats:title>\n \n Although orthostatic hypotension (\n OH<\/jats:styled-content>\n ) is a well\u2010recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (\n CVD<\/jats:styled-content>\n ) risk is controversial.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Participants with\n OH<\/jats:styled-content>\n , defined as a decrease in blood pressure (systolic \u226520\u00a0mm\u00a0Hg or diastolic \u226510\u00a0mm\u00a0Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987\u20131989) within 2\u00a0minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (\n CHD<\/jats:styled-content>\n ), any\n CHD<\/jats:styled-content>\n (combination of silent, nonfatal, and fatal\n CHD<\/jats:styled-content>\n or cardiac procedures), and all\u2010cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high\u2010sensitivity troponin T (\u22655\u00a0ng\/L) and elevated NT\u2010proBNP (N\u2010terminal pro\u2010B\u2010type natriuretic peptide; \u2265100\u00a0pg\/mL) were determined in blood collected during the second visit (1990\u20131992). All associations were adjusted for known\n CVD<\/jats:styled-content>\n risk factors. In 9139 participants (57% women; 23% black; mean age, 54\u00b15.7\u00a0years), 3% had\n OH<\/jats:styled-content>\n . During follow\u2010up (median, 26\u00a0years),\n OH<\/jats:styled-content>\n was associated with myocardial infarction (hazard ratio [\n HR<\/jats:styled-content>\n ], 1.88; 95% confidence interval [\n CI<\/jats:styled-content>\n ], 1.44\u20132.46), congestive heart failure (\n HR<\/jats:styled-content>\n , 1.65; 95%\n CI<\/jats:styled-content>\n , 1.34\u20132.04), stroke (\n HR<\/jats:styled-content>\n , 1.83; 95%\n CI<\/jats:styled-content>\n , 1.35\u20132.48), fatal\n CHD<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n , 2.77; 95%\n CI<\/jats:styled-content>\n , 1.93\u20133.98), any\n CHD<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n , 2.00; 95%\n CI<\/jats:styled-content>\n , 1.64\u20132.44), and all\u2010cause mortality (\n HR<\/jats:styled-content>\n , 1.68; 95%\n CI<\/jats:styled-content>\n , 1.45\u20131.95).\n OH<\/jats:styled-content>\n was also associated with carotid intimal thickness (\u03b2, 0.05\u00a0mm; 95%\n CI<\/jats:styled-content>\n , 0.04\u20130.07 mm), carotid plaque (odds ratio, 1.51; 95%\n CI<\/jats:styled-content>\n , 1.18\u20131.93), detectable high\u2010sensitivity troponin T (odds ratio, 1.49; 95%\n CI<\/jats:styled-content>\n , 1.16\u20131.93), and elevated\n NT<\/jats:styled-content>\n \u2010pro\n BNP<\/jats:styled-content>\n (odds ratio, 1.92; 95%\n CI<\/jats:styled-content>\n , 1.48\u20132.49).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n OH<\/jats:styled-content>\n identified in community\u2010dwelling middle\u2010aged adults was associated with future\n CVD<\/jats:styled-content>\n events and subclinical\n CVD<\/jats:styled-content>\n . Further research is necessary to establish a causal role for\n OH<\/jats:styled-content>\n in the pathogenesis of\n CVD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008884","type":"journal-article","created":{"date-parts":[[2018,5,7]],"date-time":"2018-05-07T09:20:11Z","timestamp":1525684811000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":79,"title":["Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle\u2010Aged Adults"],"prefix":"10.1161","volume":"7","author":[{"given":"Stephen P.","family":"Juraschek","sequence":"first","affiliation":[{"name":"Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"},{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Daya","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence J.","family":"Appel","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Edgar R.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John William","family":"McEvoy","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie M.","family":"Ballantyne","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX"},{"name":"Houston Methodist DeBakey Heart and Vascular Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Selvin","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"},{"name":"Johns Hopkins Medical Institutions, Baltimore, 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