Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women
Journal of Internal Medicine, Exclusive Author Commentary  Evidence Based Medicine  Clinical Article

Annweiler C, et al. – Orthostatic hypotension, a condition that mostly affects ‘oldest–old’ (i.e. >=80 years) adults, is primarily explained by age–related dysfunction of blood pressure control. Vitamin D may contribute to blood pressure control. The aim of this study was to determine whether vitamin D deficiency is associated with orthostatic hypotension in oldest–old adults. 25OHD deficiency was associated with orthostatic hypotension in oldest–old women, due to a greater drop in diastolic blood pressure on standing. This finding may lead to better understanding of the pathophysiology of falls in oldest–old adults with vitamin D deficiency.

Methods

  • Cross-sectional analysis at baseline of the EPIDOS study.
  • Five French areas.
  • A total of 329 community-dwelling oldest-old women (mean age 83.3±0.2 years).
  • Orthostatic hypotension was defined as a systolic blood pressure drop of >=20 mmHg and/or a diastolic blood pressure drop of >=10 mmHg within 3 min of standing.
  • Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25OHD) concentration <=10 ng/mL.
  • Covariates included in the models were age, body mass index, diabetes mellitus, supine mean arterial pressure, number of drugs taken per day, use of antihypertensive or psychoactive drugs, cognition, quadriceps strength, current smoking, alcohol consumption, serum concentrations of parathyroid hormone, calcium and creatinine and season of testing.

Results

  • Diastolic orthostatic hypotension was observed more often among women with vitamin D deficiency (19.2%) compared to those without (10.0%; P = 0.03).
  • There was an inverse linear association between 25OHD concentration and change in diastolic blood pressure after 3 min of standing (adjusted {beta} = -0.07, P = 0.046).
  • Similarly, 25OHD deficiency was associated with orthostatic hypotension [adjusted odds ratio (OR) 3.36, P = 0.004], specifically with diastolic orthostatic hypotension (adjusted OR 3.81, P = 0.003).

Vitamin D deficiency was associated with orthostatic hypotension in oldest-old women, due to a greater drop in diastolic blood pressure on standing. This new orientation of research may offer a powerful mechanism to elucidate the pathophysiology of falls in oldest-old adults with vitamin D deficiency.

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