Orthostatic Hypotension and Risk of Venous Thromboembolism in 2 Cohort Studies

Elizabeth J. Bell, Sunil K. Agarwal, Mary Cushman, Susan R. Heckbert, Pamela L. Lutsey, Aaron R. Folsom

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4 Scopus citations


BACKGROUND: Although venous stasis is a risk factor for venous thromboembolism (VTE) and orthostatic hypotension (OH) can cause venous stasis, to our knowledge no study has examined the relationship between OH and VTE risk. We sought to quantify the association between OH and VTE (deep vein thrombosis or pulmonary embolism) using data from 2 large, prospective cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) Study. We hypothesized that OH was positively associated with incident VTE. METHODS: We measured OH - defined as a drop in systolic blood pressure (SBP) of at least 20mm Hg or diastolic blood pressure (DBP) of at least 10mm Hg within 3 minutes of standing - in participants aged 45-64 years in ARIC (n = 12,480) and ≥65 years in CHS (n = 5,027) at baseline visits (1987-1989 in ARIC; 1989-1990 and 1992-1993 in CHS), and followed participants for incident VTE (n = 568 in ARIC through 2011 and n = 148 in CHS through 2001). We calculated adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident VTE in relation to OH status. RESULTS: In CHS, there was a positive association between OH status and incident VTE (HR for VTE = 1.74 (95% CI: 1.20-2.51)). In contrast, there was no association between OH and VTE in the ARIC study (HR for VTE = 0.97 (95% CI: 0.70-1.33)). CONCLUSIONS: Community-dwelling older adults with OH had a moderately increased risk of VTE. These results were not seen in a population-based middle-aged cohort.

Original languageEnglish (US)
Pages (from-to)634-640
Number of pages7
JournalAmerican journal of hypertension
Issue number5
StatePublished - May 1 2016

Bibliographical note

Funding Information:
We thank staff and participants of the ARIC and CHS studies for their important contributions. The ARIC Study was carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). CHS was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant U01HL080295 from the NHLBI, with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). E.J.B. was supported by NHLBI training grant T32HL007779.


  • blood pressure
  • epidemiology
  • hypertension
  • orthostatic hypotension
  • orthostatic intolerance
  • risk factors
  • venous thromboembolism

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