Skip to main content
Download PDF

Prevalence of orthostatic hypotension and associated factors among older people with hypertension in Northern Ethiopia

BMC Geriatrics volume 24, Article number: 928 (2024) Cite this article

Abstract

Background

The prevalence of hypertension increases with age, and older people with this condition are at increased risk of developing orthostatic hypotension (OH) due to age-related changes in blood pressure regulation mechanisms as well as prescribed medications. OH increases the risk of falls, often with subsequent fractures as well as other morbidity and even mortality. The prevalence and characteristics of OH in older people with hypertension in Low-Income Countries have not been well characterized. This study aims to determine the prevalence of OH and associated factors among older people with hypertension in northern Ethiopia.

Method

A hospital-based cross-sectional study was conducted using a convenience sample of patients aged 60 years and older with hypertension receiving pharmacotherapy and followed up at the University of Gondar Hospital, Ethiopia. Blood pressure (BP) was measured in the supine position, and after 3 min of standing; the level of BP drop (> 20/10) was used to define measured OH. Data regarding symptoms of OH were also collected using the Orthostatic Hypotension Questionnaire (OHQ). The data were entered into Microsoft Excel version 2016 and exported to SPSS version 20 for statistical analysis. Logistic regression analysis was conducted to assess the factors associated with OH.

Results

A total of 240 participants were included, with a mean age of 68.8 ± 7.1 years. The prevalence of OH was 23.8% (CI: 21.5%, 26.1%). Of the medications used, calcium channel blocker (CCBs) treatment was strongly associated with OH (AOR = 2.03[95%CI = 1.08–3.8]). Two-thirds (61.4%) of participants with measured OH experienced relevant symptoms of OH.

Conclusion

There was a high prevalence of OH among older patients with hypertension attending a tertiary care hospital in Gondar, with one in four affected. The use of CCBs was identified as an independent risk factor for OH. Most patients with OH experienced relevant symptoms, so monitoring this condition in this group may help prevent adverse consequences.

Peer Review reports

Introduction

Hypertension is a highly prevalent disease, with a global prevalence of approximately 1.3 billion, with the vast majority of these people( 82%) living in low- and middle-income countries (LMICs) [1]. Hypertension is a common problem in older adults, reaching a prevalence of 70 to 80% [2] in high- income countries (HICs). Orthostatic hypotension (OH) commonly occurs in patients taking antihypertensive medications. OH has been defined as a sustained reduction of systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure of at least 10 mmHg, when assuming a standing position or during a head-up tilt test of at least 60o [3]. OH occurs when either cardiac output is reduced, the vasoconstrictor response is insufficient, or both. Causes of OH can be classified as neurogenic or non-neurogenic, with patients exhibiting either symptomatic or asymptomatic presentations. Common symptoms include lightheadedness, weakness, difficulty concentrating, blurred vision, pre-syncope, syncope, falls, and headache [4,5,6].

Several risk factors have been identified for the development of OH. Medications such as antihypertensive drugs, antidepressants, any potential cause of dehydration or hypovolemia, and relevant comorbidities such as Parkinson disease, and diabetes mellitus are all factors that can be associated with OH [7]. Aging itself, even in a relatively healthy person is associated with a significant increased risk of OH [8] with prevalence rates in older population ranging from 6 to 35% in high income countries [3]. OH in this population can result from any or combination of normal age-related changes, comorbidities such as diabetes, hypertension, renal, and cardiovascular diseases, as well as medications used to treat these conditions [8,9,10].

OH has been associated with all-cause mortality, myocardial infarction, heart failure, cardiac arrhythmias, transient ischemic attack, and stroke [7, 11, 12]. OH can significantly reduce quality of life [13] and increase the risk of fall and subsequent fractures [7]. There is not always an effective treatment for OH, but managing factors like medications, dehydration, patient education, early recognition, fall prevention, avoiding triggers, and increasing salt and water intake can often help [3, 12].

The absolute majority of patients with hypertension are to be found in low income countries (LICs). For its part, Ethiopia is a LIC with a population of over 120,000,000, almost 4% of whom are > 60 years. As is the case in many LMICs, while the percentage of older people in Ethiopia will rise relatively slowly (because of the large denominator of children), the absolute number of older people and the challenges they present to their families and society will rise exponentially over the coming decades [14]. Due primarily to the reduction of communicable diseases and improvement in maternal and child health from 1990 to 2015, the life expectancy of the Ethiopian population has increased by 18 years, and this demographic transition has resulted in an increased prevalence of non- communicable diseases(NCDs) [15]. As in most LICs, hypertension prevalence is rising in Ethiopia, with aging being the most common risk factor [16].

Given the frequent association with adverse effects, it is important to estimate the prevalence of OH among the aging population, especially as there has been little research into the phenomenon in LICs [13, 17]. Screening vulnerable patients for OH through a simple blood pressure measurement, taken supine or sitting and then standing after 3 min, can provide significant public health benefits by helping to mitigate its adverse effects [8].

To the best of our knowledge, there have not been many studies assessing the prevalence of OH and factors associated with it among older people with hypertension in Ethiopia. That being said a prevalence study on OH in patients with hypertension conducted at our institution reported a prevalence of 17.6%. However, this analysis included only males at all ages [18]. The aim of the present study was to assess the magnitude of OH and associated factors specifically in older people with hypertension in the outpatient setting of a tertiary care hospital in northwest Ethiopia.

Methodology

Study design and setting

A hospital-based cross-sectional study was conducted from May to July 2022 at the University of Gondar Hospital (UoGH), Northwest Ethiopia. UoGH is a tertiary-level teaching specialized public hospital with a total capacity of over 800 beds, and it provides services in both outpatient and inpatient settings. The hospital is located in northern Ethiopia in the city of Gondar with a population of more than 800,000, and it serves as a referral center for patients coming from the whole northwest part of the country, serving a large catchment area containing about 7 million. Approximately 120 patients with hypertension from all over the catchment area are seen in the biweekly scheduled hypertension clinic in the hospital’s outpatient chronic diseases follow up clinic. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure transparent and accurate reporting (https://www.strobe-statement.org/), a completed STROBE checklist is provided in Table S1.

Study population, sample size and sampling technique

The study population was a convenience sample drawn consecutively from those older people with hypertension undergoing follow-up at the clinic. Inclusion criteria were all patients with hypertension on pharmacologic treatment for at least 6 months having follow up at UoGH during the study period and age > = 60 years. Exclusion criteria include critically ill patients, those with difficulty in standing or maintaining balance, aphasia, dementia, or psychiatric problems.

The sample size was determined based on findings from a systematic review and meta-analysis, which indicated a pooled prevalence of orthostatic hypotension among people with hypertension to be 20% [19]. Assuming that 20% of people with hypertension in the population have OH, and estimating the expected proportion with 5% absolute precision and 95% confidence interval, the sample size was calculated to be 240. Subjects were consecutively recruited until the sample size was attained.

Study variables and operational definition

The outcome variable of interest was the presence of OH symptomatic or not. The independent variables include demographics such as age and sex, duration of hypertension, co-morbidities, and type and number of antihypertensive medications.

“OH” was defined as a fall in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg after 3 min of changing from supine to standing position [20].

“Symptomatic OH” was defined as those hypertensive patients with measured OH having at least one symptom from the Orthostatic Hypotension Symptom Assessment (OHSA) scale [21].

“Controlled blood pressure” was defined as blood pressure < 140/90mmHg while on antihypertensive treatment and “uncontrolled BP” as blood pressure > = 140/90mmHg while on antihypertensive treatment.

Data collection tools, clinical measurements and procedures

Data were collected from consecutive patients at the clinic who met al.l selection criteria using an interviewer-administered structured questionnaire. The data collectors were two trained general practitioners. Socio-demographic data, comorbidities, and lists of prescribed medications were retrieved from the patient interview and review of medical records. The measurement of BP was according to the guidelines for the European Society of Hypertension [2, 22]. Participants were first asked if they had smoked or drank coffee in the previous 30 min and if not, were instructed to sit comfortably with the back support for 5 min in the clinic after which the BP was measured. Using an appropriate cuff size, with the arm supported comfortably BP was measured using an aneroid mercury sphygmomanometer via the auscultatory method.

Blood pressure was first measured in the sitting position in both arms. The value recorded from the arm with the higher values was used to define the current BP control status. To establish the baseline blood pressure in the supine position, the patient rested while lying down for 5 min. Beginning with the non-dominant arm, three blood pressure measurements were alternated between arms (e.g., left-right-left or vice versa). The average of the three readings in the supine position was utilized for analysis. Subsequently, two continuous blood pressure measurements were taken on the left arm, positioned at heart level, at 1 min and 3 min after assuming a standing position. The blood pressure measurement at 3 min was utilized to determine any postural drop. If the blood pressure reading during the erect posture at three minutes indicated a reduction of systolic blood pressure ≥ 20 mmHg or diastolic blood pressure ≥ 10 mmHg, the patient was categorized as having OH. These participants were further assessed for the presence of OH symptoms using the OHSA scale): Validation of a novel symptom assessment scale according to Kaufmann H et al. [21].

Initially, each of the six orthostatic hypotension symptoms was assigned a score ranging from zero to ten (none [0] to the worst possible [10]) with the mean score for each symptom then calculated. Individuals with a score equal to or above the mean were classified as experiencing that specific symptom, while those with a score below the mean were deemed to have no symptoms. If a patient exhibited at least one of the six symptoms, they were categorized as having “symptomatic orthostatic hypotension.” Similarly, interference in daily activities was evaluated. Activities necessitating standing and walking for short and long durations were rated on a scale from zero to ten (no interference [0] to complete interference [10]), and the mean interference score for each activity was computed. Participants scoring equal to or above the mean were identified as experiencing interference in daily activities, whereas those scoring below the mean were regarded as having no interference in daily activities.

Data analysis

The data were entered into Microsoft Excel version 2016 and then exported to SPSS version 20 for statistical analysis. Baseline characteristics were described using numbers and percentages. Continuous variables were presented as means and standard deviations, while categorical variables were presented as frequency and percentage.

Both bivariate and multivariate logistic regression analyses were employed to identify independently associated factors of orthostatic hypotension (OH). Variables with a P-value < 0.2 in the bivariate analysis were included in the multivariate analysis to control for potential confounders. Statistical significance was defined as P < 0.05. No missing values were observed in the dataset, and all cases were included in the analysis.

Results

Socio-demographic characteristics

A total of 250 older people with hypertension who met our study criteria were approached, and 240 responded positively (response rate = 94.4%). The mean (SD) age of the participants was 68.8 (SD7.1) years with a range of 60–92 years. Just over half of the participants (n = 132 [55.2%]) were female, and the majority (n = 190 [79.8%]) reported urban residency. For the most part, our subjects had low educational attainment, with only 22 (9.2%) participants holding a university diploma and beyond. See Table 1.

Table 1 Socio-demographic characteristics of older people with hypertension on antihypertensive treatment (n = 240)
Full size table

Comorbidities among elderly hypertensive patients on anti-hypertensive treatment (N = 240)

The majority (n = 165 [68.8%]) of participants had at least one comorbidity. Diabetes mellitus was the most common condition (26.7%), followed by cardiovascular disease (22.5%), dyslipidemia (13.8%), and chronic kidney disease (7.5%). See Table 2.

Table 2 Co-morbidities among older people with hypertension on antihypertensive treatment (n = 240)
Full size table

Antihypertensive and other common concomitant medications

Calcium channel blockers, angiotensin converting enzyme inhibitors, and thiazide diuretics were the most commonly prescribed antihypertensive medications, with calcium channel blockers as the most commonly used single antihypertensive medication. Most patients were on combinations of different classes of antihypertensive medications, with calcium channel blockers plus angiotensin converting inhibitors being the most common combination. The mean (SD) number of antihypertensive pills was 1.7 (± 0.68). See Table 3. Other concomitant medications used by patients include aspirin, statins, and antidiabetic medications. See Table 4.

Table 3 Types of antihypertensive medications used in older people with hypertension on treatment (n = 240)
Full size table
Table 4 Other concomitant medications used in older people with hypertension on antihypertensive treatment (n = 240)
Full size table

Prevalence of Orthostatic hypotension and blood pressure control status OH

Prevalence was 23.8% (CI: 21.5%, 26.1%) of whom almost two thirds (61.4%) were symptomatic. Just under two-thirds {154(64.2%)} of the participants exhibited adequate blood pressure control (i.e. BP < 140/90).

Factors associated with OH

Bi-variable logistic regression was conducted for variables including age, gender, and presence of comorbidities such as diabetes mellitus, cardiovascular disease, chronic kidney disease, dyslipidemia, toxic goiter and HIV. Duration of hypertension, number of antihypertensive medications, and type of antihypertensive medications such as CCBs, ACE, HCT, and BP-control status were also measured. Variables with p-value of 0.20 or less, namely, use of Calcium channel blocker, Toxic goiter, BP control status, and Beta Blocker use were taken to multivariable logistic regression. Our Bivariate analysis showed that OH was associated with use of CCBs, presence of toxic goiter and poor BP control status. However multivariate analysis revealed that only CCBs use (AOR = 2.029[95%CI = 1.084–3.799]) and presence of toxic goiter (AOR = 0.133[95%CI = 0.021–0.858]) influenced OH. Table 5.

Table 5 Factors associated with OH among older people with hypertension on treatment (N = 240)
Full size table

Assessment of symptoms of OH using OH symptom assessment (OHSA) and OH daily activity scales (OHDAS)

Those participants who exhibited measured OH were assessed for symptoms of OH and any interference with their activities of daily living. Pertaining to OH symptoms, almost two thirds 35/57 (61.4%) patients exhibited at least one symptom. The frequency of each symptom of OH and interference with daily activity is shown on Table 6.

Table 6 Orthostatic Hypotension Questionnaire (OHQ) using symptoms assessment (OHSA) and OH daily activity scale (OHDAS) in participants with OH, n = 57
Full size table

Discussion

The primary aim of the study was to determine the prevalence of measured and symptomatic OH and its associated factors among people over 60 years of age with hypertension in Ethiopia, a low income country. The prevalence of OH among the study participants was found to be almost one quarter (23.8%) of those attending the clinic. Previous studies, mostly in HICs, have indicated that OH prevalence varies based on the age of population, study setting, method of blood pressure measurements and presence of comorbidities. From a systematic review and meta-analysis, the pooled prevalence of OH in the general population, primarily from studies conducted in Western countries, was found to be 17%, 19% and 31% in community, primary care and institutional care cohorts respectively [19]. In another systematic review, the pooled prevalence of OH in community-dwelling older people was 22.2% while it was only slightly higher (23.9%) in long term settings [23]. In another systematic review which assessed the prevalence of OH specifically in older persons, the pooled prevalence of continuously measured initial OH was, not surprisingly, higher than in younger populations at 35.5% [24]. In studies from LICs, the prevalence of OH among ambulatory elderly Asian population was only 11.0% [7] while a community-based study in Nigeria found a prevalence of 14.8% [7, 25], both lower than in our study. These findings underscore the variability in OH prevalence across different populations and settings, highlighting the importance of considering various factors in understanding the prevalence of OH.

Our study found one of the highest prevalence rates of OH in older people reported. This may be because of selection bias in that the study setting was institution-based albeit of ambulatory patients. Another important reason for this high prevalence could be that we studied older people with hypertension. Age and hypertension with concomitant use of blood pressure lowering medications are known factors that can increase the occurrence of OH [19, 25, 26]. In observational studies, approximately 1 in 10 individuals at any age with hypertension have measured OH [27].

A prevalence study on OH in patients with hypertension of all ages but only males from our own institution reported a prevalence of 17.6% [18]. The fact that our study included older people of both sexes groups may explain the differences in the results.

We found that the use calcium channel blockers as antihypertensive treatment was strongly associated with occurrence of OH (AOR = 2.03[95%CI = 1.08–3.8]). In line with our results, previous literature suggests that multiple medications have been linked to an increased risk of OH with drug-induced OH being the most common reason for presentation to emergency department with OH [28]. Non-neurogenic medications such as vasodilators, diuretics, tricyclic antidepressants are the commonest cause of OH [29]. Consistent with our findings, previous studies indicated that use of calcium channel blockers in geriatric practice increased the risk of OH [30, 31].

In the present study, the eight participants with toxic goiter (hyperthyroidism) on treatment were 10% less likely to develop OH than without toxic goiter, a finding difficult to explain. That being said, the number of patients with this comorbidity was limited, resulting in a wide confidence interval. As such, this data should be interpreted with caution. although we do know that thyroid diseases have been implicated as causes secondary chronic autonomic failure and OH [9]. Previous reports indicate an association between hypothyroidism, thyrotoxicosis, and Graves’ disease with OH [32,33,34].

Despite being consistent users of our clinic, the majority (64.2%) of the study participants in our study have uncontrolled BP. We did not find any association between BP levels and OH and this was an unexpected result. Previous studies have shown that, regardless of treatment status or diagnosed hypertension, raised blood pressure was strongly associated with OH [31, 35].

Patients with OH can be symptomatic or asymptomatic and symptomatic hypotension is itself associated with morbidity or cardiovascular mortality [5] In our study, from the participants with OH, 35/57(61.4%) had reported to have experienced symptoms. Common symptoms of symptomatic OH include but are not limited to; lightheadedness, weakness or tiredness, thinking or concentrating difficulties, blurred vision, pre-syncope, and syncope [6]. OH symptoms can adversely impact quality of life and in some cases may be incapacitating. However, there is poor relationship between the magnitude of the orthostatic BP fall and the degree of symptoms [36].

The proportion of symptomatic OH varies across studies depending on the method used to assess symptoms. For instance, a previous study found that OH symptoms were present in a quarter(25.6%) of older patients with hypertension in primary care [37]. A third of participants with OH in our study did not report any symptom of OH and this was consistent with previous work [38]. A study assessing symptoms in OH patients using the same tool that we used(OHQ), revealed that 57% reported symptoms of orthostatic intolerance with standing; 55% after physical activity [36] and this was consistent with our study.

Limitations

This was an institution-based study and did not include a random sample of community-dwelling older people with hypertension. Therefore, our sample may not accurately represent the older population in the community. As symptoms were actively queried, our results may have overestimated the recognition of symptoms resulting in information bias. Also, our study may be susceptible to recall bias. As the study setting took place in an outpatient department, it may have underestimated the overall magnitude of OH since hospitalized patients with potential serious comorbidities were not included. Conversely, we may have overestimated what would be found in a random sample of community dwelling people with hypertension. This was a cross-sectional study and as such we were not able to assess averse outcomes of OH such as falls, fractures and cardiovascular events.

Strengths include the fact that our study is to the best of our knowledge, one of the very few which assessed OH prevalence among older people with hypertension in a low-income country. As well, there was no intrinsic reason to believe that ours weren’t the typical patients with hypertension one sees in OPD settings in many LICs. As well we used a standardized symptom assessment instrument.

Conclusions

Our study indicates that among older people (60+) with hypertension in Ethiopia, a low-income country, there was a high prevalence of measured OH, with one out of four individuals affected. The majority of patients with measured OH experience relevant symptoms. All older people with hypertension should be closely monitored for OH and queried about symptoms if a measurable drop in blood pressure is found. Further large-scale studies, including random sample community-dwelling, are needed to determine the actual magnitude of OH and its associated factors.

Data availability

All the data generated or analyzed during this study are included in this published article. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request (email: workhailu@yahoo.com).

Abbreviations

OH:

orthostatic hypotension

BP:

blood pressure

OHQ:

Orthostatic Hypotension Questionnaire

AOR:

adjusted odds ratio

COR:

crude odds ratio

LMICs:

low- and middle-income countries

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

NCDs:

non-communicable diseases

UoGH:

University of Gondar hospital

OHSA:

Orthostatic Hypotension Symptom Assessment

SD:

standard deviation

COPD:

Chronic obstructive pulmonary disease

CCB:

Calcium Channel blockers

ACEi:

angiotensin converting enzyme inhibitors

HCT:

hydrochlorothiazide

BB:

beta blockers

ARBs:

angiotensin receptor antagonists

OHDAS:

orthostatic hypotension daily activity scale

References

  1. Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, NCD Risk Factor Collaboration (NCD-RisC. *). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–80.

  2. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American college of cardiology/American Heart Association task. Hypertension. 2018;71:1269–324.

  3. Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, Zimarino M, De Caterina R. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36(25):1609–17.

    Article  PubMed  Google Scholar 

  4. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, Van Dijk JG. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72.

    Article  PubMed  Google Scholar 

  5. Alagiakrishnan K, Patel K, Desai RV, Ahmed MB, Fonarow GC, Forman DE, White M, Aban IB, Love TE, Aronow WS, Allman RM, Anker SD, Ahmed A. Orthostatic hypotension and incident heart failure in community-dwelling older adults. Journals Gerontol - Ser Biol Sci Med Sci. 2014;69 A(2):223–30.

    Google Scholar 

  6. Low PA, Opfer-Gehrking TL, McPhee BR, Fealey RD, Benarroch EE, Willner CL, Suarez GA, Proper CJ, Felten JA, Huck CA, Corfits JL. Prospective Evaluation of Clinical Characteristics of Orthostatic Hypotension. Mayo Clin Proc. 1995;70(7):617–22. https://doiorg.publicaciones.saludcastillayleon.es/10.4065/70.7.617

  7. Hiitola P, Enlund H, Kettunen R, Sulkava R, Hartikainen S. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens. 2009;23(1):33–9.

    Article  PubMed  CAS  Google Scholar 

  8. Allhoff P, Laaser U, Heinrich J, Allhoff P, Laaser U, Heinrich J. The Honolulu Heart Program. Kompend Der Lipid-Studien. 1991;70–1.

  9. Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: Epidemiology, prognosis, and treatment. J Am Coll Cardiol. 2015;66(7):848–60.

    Article  PubMed  Google Scholar 

  10. Wu JS, Yang YC, Lu FH, Wu CH, Chang CJ. Population-based study on the prevalence and correlates of orthostatic hypotension/hypertension and orthostatic dizziness. Hypertens Res. 2008;31(5):897–904.

    Article  PubMed  Google Scholar 

  11. Brignole M, Moya A, De Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed M, Rice CP, Sutton R, Ungar A, Van Dijk JG. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883–948.

    Article  PubMed  Google Scholar 

  12. Luukinen H, Koski K, Laippala P, Kivelä SL. Prognosis of diastolic and systolic orthostatic hypotension in older persons. Arch Intern Med. 1999;159(3):273–80.

    Article  PubMed  CAS  Google Scholar 

  13. Claassen DO, Adler CH, Hewitt LA, Gibbons C. Characterization of the symptoms of neurogenic orthostatic hypotension and their impact from a survey of patients and caregivers. BMC Neurol. 2018;18(1):1–9.

    Article  Google Scholar 

  14. Clarfield AM. The ones we seldom see: old folks in Young Countries. J Am Geriatr Soc. 2019;67(11):2240–4.

    Article  PubMed  Google Scholar 

  15. Balew G, Id J, Cho Y, Jung M. Decomposition of Ethiopian Life expectancy by age and cause of mortality; 1990–2010. 2016;1–15.

  16. Shukuri A, Tewelde T, Shaweno T. Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia. Integr Blood Press Control. 2019;12:23–31.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fagard RH, De Cort P. Orthostatic hypotension is a more robust predictor of cardiovascular events than nighttime reverse dipping in elderly. Hypertension. 2010;56(1):56–61.

    Article  PubMed  CAS  Google Scholar 

  18. Getu AA, Abuhay DA, Goshu BT. Orthostatic hypotension in male hypertensive patients: a cross-sectional study at the university of Gondar comprehensive specialized hospital, Gondar, Ethiopia. Integr Blood Press Control. 2021;14:133–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McDonagh STJ, Mejzner N, Clark CE. Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC Fam Pract. 2021;22(1):1–23.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Schatz IJ, Bannister R, Freeman RL, Goetz CG, Jankovic J, Kaufmann HC, Koller WC, Low PA, Mathias CJ, Polinsky RJ, Quinn NP, Robertson D, Streeten DHP. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46(5):1470.

    Article  Google Scholar 

  21. Kaufmann H, Malamut R, Norcliffe-Kaufmann L, Rosa K, Freeman R. The Orthostatic Hypotension Questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res. 2012;22(2):79–90.

    Article  PubMed  Google Scholar 

  22. Brien EO, Asmar R, Beilin L, Imai Y, Mallion J, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, Pickering T, Redon J. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement Jan Staessen, George Stergiou and Paolo Verdecchia, on behalf of the European Society of Hypertension Working Group on blood pressure Moni. J Hypertens. 2003;821–48.

  23. Saedon NIZ, Tan MP, Frith J. The prevalence of orthostatic hypotension: a systematic review and meta-analysis. Journals Gerontol - Ser Biol Sci Med Sci. 2020;75(1):117–22.

    Google Scholar 

  24. Tran J, Hillebrand SL, Meskers CGM, Iseli RK, Maier AB. Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50(5):1520–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kenechukwu E. Prevalence of Orthostatic Hypotension in the Elderly in Anambra State. Sci J Clin Med. 2018;7(4):30.

    Article  Google Scholar 

  26. Sasidharan A, Ambatipudi S. A community-based cross-sectional survey of orthostatic hypotension among elderly from south India. Indian Heart J. 2022;74(6):478–83. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ihj.2022.11.007

  27. Inbar Raber MJ, Belanger R, Farahmand R, Aggarwal N, Chiu MA, Rifai, Alan P. Jacobsen LAL and SPJ. Orthostatic hypotension in hypertensive adults: Harry Goldblatt Award for Early Career investigators 2021. Hypertension. 2022;79(11):2388–96.

    Article  PubMed  Google Scholar 

  28. Dani M, Dirksen A, Taraborrelli P, Panagopolous D, Torocastro M, Sutton R, Lim PB. Orthostatic hypotension in older people: considerations, diagnosis and management. Clin Med J R Coll Physicians Lond. 2021;21(3):E275–82.

    Google Scholar 

  29. Angelousi A, Girerd N, Benetos A, Frimat L, Gautier S, Weryha G, Boivin JM. Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertens. 2014;32(8):1562–71.

    Article  PubMed  CAS  Google Scholar 

  30. Press Y, Punchik BFT. Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit. J Hypertens. 2016;34(2):351–8.

    Article  PubMed  CAS  Google Scholar 

  31. Gaxatte C, Faraj E, Lathuillerie O, Salleron J, Deramecourt V, Pardessus V, Destailleur MH, Boulanger E, Puisieux F. Alcohol and psychotropic drugs: risk factors for orthostatic hypotension in elderly fallers. J Hum Hypertens. 2017;31(4):299–304.

    Article  PubMed  CAS  Google Scholar 

  32. Hajjar I. Postural blood pressure changes and orthostatic hypotension in the elderly patient: impact of antihypertensive medications. Drugs Aging. 2005;22(1):55–68.

    Article  PubMed  CAS  Google Scholar 

  33. Han Y-J, Yu Z-Y, Miao R, Chen S. Graves’ Disease Combined with Orthostatic Hypotension: a two-case report. Mil Med. 2023;188(3–4):814–43.

    Google Scholar 

  34. Blum I, Barkan A, Yeshurun D. Thyrotoxicosis presenting as orthostatic hypotension. Postgrad Med J. 1980;56(656):425–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British women’s Heart and Health Study. Age Ageing. 2009;39(1):51–6.

    Article  PubMed  Google Scholar 

  36. Freeman R, Illigens BMW, Lapusca R, Campagnolo M, Abuzinadah AR, Bonyhay I, Sinn DI, Miglis M, White J. Gibbons CH. Symptom Recognition is impaired in patients with Orthostatic Hypotension. Hypertension. 2020;75(5):1325–32.

    Article  PubMed  CAS  Google Scholar 

  37. Rovere-Querini P, De Lorenzo R, Conte C, Brioni E, Lanzani C, Yacoub MR, Chionna R, Martinenghi S, Vitali G, Tresoldi M, Ciceri F. Prevalence of orthostatic hypotension in elderly hypertensive patients in primary care. Atención Primaria. 2021;28(3):151–7.

    Google Scholar 

  38. Arbogast SD, Alshekhlee A, Hussain Z, McNeeley KCT. Hypotension unawareness in profound orthostatic hypotension. Am J Med. 2009;122(6):574–80.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the study participants, the data collectors and the health personnel involved in patient care.

Funding

This research received no specific grant from any funding Agency.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Workagegnehu Hailu & Tsebaot Tesfaye

  2. Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Lemma Derseh

  3. College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia

    Awraris Hailu

  4. Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel and McGill University, Montréal, Canada

    A. Mark Clarfield

Authors
  1. Workagegnehu Hailu
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Tsebaot Tesfaye
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Lemma Derseh
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Awraris Hailu
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. A. Mark Clarfield
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

TT and WH contributed to the conception, design, data collection, initial manuscript writing, and review of the manuscript. AMC contributed to the conception, design, writing and review of the manuscript. LD and AH contributed to the conception, data analysis and review of the manuscript. All the authors read and approved the final manuscript and approved its submission for publication.

Corresponding author

Correspondence to Workagegnehu Hailu.

Ethics declarations

Ethics approval and consent to participate

Ethical clearance was obtained from the University of Gondar Institutional Review Board (Ref. No. V/P/RCS/05/1734/2020. Date: May 13, 2020). Informed consent was obtained from each participant prior to their involvement in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hailu, W., Tesfaye, T., Derseh, L. et al. Prevalence of orthostatic hypotension and associated factors among older people with hypertension in Northern Ethiopia. BMC Geriatr 24, 928 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05519-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05519-8

Keywords

BMC Geriatrics

ISSN: 1471-2318

Contact us