Orthostatic hypotension and health outcomes: an umbrella review of observational studies

  • Pinar SoysalEmail author
  • Nicola Veronese
  • Lee Smith
  • Gabriel Torbahn
  • Sarah E. Jackson
  • Lin Yang
  • Andrea Ungar
  • Giulia Rivasi
  • Martina Rafanelli
  • Mirko Petrovic
  • Stefania Maggi
  • Ahmet Turan Isik
  • Jacopo Demurtas
  • The Special Interest Groups in Systematic Reviews and Meta-analyses for Healthy Ageing, and Cardiovascular Medicine of the European Society of Geriatric Medicine (EuGMS)
Research Paper

Key summary points


To investigate potential relationships between orthostatic hypotension (OH) and negative health outcomes and mortality, through an umbrella review with integrated meta-analyses.


Orthostatic hypotension is significantly associated with several negative outcomes in older people, but a suggestive evidence is available only for higher risk of coronary heart disease congestive heart failure, stroke, falls dementia, and all-cause mortality.


Orthostatic hypotension seems to be significantly associated with several negative health outcomes in older people, even if only associations with coronary heart disease, congestive heart failure, stroke, falls, dementia, and all-cause mortality are supported by suggestive evidence.



Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses.


We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria.


From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12–1.56), stroke (HR = 1.22, 95% CI 1.08–1.38), congestive heart failure (HR = 1.30, 95% CI 1.09–1.55), all-cause mortality (RR = 1.50, 95% CI 1.24–1.81), falls (OR = 1.84, 95% CI 1.39–2.44), and dementia (HR = 1.22, 95% CI 1.11–1.35).


The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.


Orthostatic hypotension Umbrella review Meta-analysis Mortality Fall Heart failure Heart disease Stroke 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

It was not requested being a revision of already published literature. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No patients were included in this review.

Sponsor’s role


Supplementary material

41999_2019_239_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 37 kb)


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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  • Pinar Soysal
    • 1
    Email author
  • Nicola Veronese
    • 2
  • Lee Smith
    • 3
  • Gabriel Torbahn
    • 4
  • Sarah E. Jackson
    • 5
  • Lin Yang
    • 6
  • Andrea Ungar
    • 7
  • Giulia Rivasi
    • 7
  • Martina Rafanelli
    • 7
  • Mirko Petrovic
    • 8
  • Stefania Maggi
    • 2
  • Ahmet Turan Isik
    • 9
  • Jacopo Demurtas
    • 10
  • The Special Interest Groups in Systematic Reviews and Meta-analyses for Healthy Ageing, and Cardiovascular Medicine of the European Society of Geriatric Medicine (EuGMS)
  1. 1.Department of Geriatric Medicine, Faculty of MedicineBezmialem Vakif UniversityIstanbulTurkey
  2. 2.National Research CouncilNeuroscience InstitutePaduaItaly
  3. 3.The Cambridge Centre for Sport and Exercise SciencesAnglia Ruskin UniversityCambridgeUK
  4. 4.Institute for Biomedicine of AgingFriedrich Alexander University Erlangen-NürnbergNurembergGermany
  5. 5.Department of Behavioural Science and HealthUniversity College LondonLondonUK
  6. 6.Department of Cancer Epidemiology and Prevention ResearchAlbert Health ServicesCalgaryCanada
  7. 7.Department of GeriatricsAzienda Ospedaliero-Universitaria Careggi and University of FlorenceFlorenceItaly
  8. 8.Department of Internal Medicine, Section of GeriatricsGhent UniversityGhentBelgium
  9. 9.Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of MedicineDokuz Eylul UniversityIzmirTurkey
  10. 10.Primary Care Department Azienda USL Toscana Sud EstGrossetoItaly

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