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Seniors with more vitamin D are less light-headed (Orthostatic Hypotension) - many studies

Hypotention 3.4 X more likely if low vitamin D – June 2016

Factors associated with orthostatic hypotension in hospitalized elderly patients - June 2016
Aging Clin Exp Res. 2016 Jun;28(3):513-7. doi: 10.1007/s40520-015-0451-z. Epub 2015 Oct 19.
Guérin A1, Bureau ML1, Ghazali N1, Gervais R1, Liuu E1, Seité F1, Bellarbre F2, Ingrand P3,4, Paccalin M5.
1 Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France.
2 Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France. fabienne.bellarbre at chu-poitiers.fr.
3 Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
4 INSERM, CIC-P 1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
5 Pôle de Gériatrie, CHU La Milétrie, 86021, Poitiers Cedex, France. m.paccalin at chu-poitiers.fr.

OBJECTIVE: To assess the factors associated with orthostatic hypotension (OH) in hospitalized elderly patients.

DESIGN: Prospective observational single center study.

SETTING: A French academic center.

PARTICIPANTS: One hundred and thirty-one patients without OH symptoms who underwent OH testing.

The OH test was performed when the patient was able to get out of the bed and was no longer receiving parenteral fluids. The blood pressure was measured after a 10-min rest while the patients were sitting and then standing at 1 and 3 min. Demographic data, co-morbidities, current medications and biological parameters were recorded.

The mean patient age was 84.3 ± 7 years. The mean CIRS-G score was 10.6 ± 3.8. The OH test was performed 6.3 ± 3.9 days after admission and was positive in 39 (29.8 %) patients (95 % confidence interval (CI) 22, 38) and positive at 1 min in 87.2 % of the cases. Multivariate analysis showed that OH prevalence correlated with diabetes (odds ratio (OR) = 4.23; 95 % CI 1.10, 16.24; P = 0.03), serum 25-hydroxyvitamin D <20 ng/ml (OR = 3.38; 95 % CI 1.36, 8.42; P = 0.008), use of tranquilizers (anxiolytic and hypnotic) (OR = 2.96; 95 % CI 1.18, 7.4; P = 0.02), CIRS-G score (OR = 1.15; 95 % CI 1.01, 1.31; P = 0.03) and lack of diuretics (OR = 0.20; 95 % CI 0.06, 0.63; P = 0.005).

In older adults, OH is often misdiagnosed because it is asymptomatic. As practitioners may be reluctant to perform the OH test because of time constraints, targeting a subgroup of patients with a higher risk of OH should be worthwhile to prevent further OH complications.

PMID: 26482745 DOI: 10.1007/s40520-015-0451-z

Orthostatic hypotension 2X more likely if low vitamin D - meta-analysis March 2016

Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis.
J Hypertens. 2016 Mar 28. https://doi.org/10.1097/HJH.0000000000000907
Ometto F1, Stubbs B, Annweiler C, Duval GT, Jang W, Kim HT, McCarroll K, Cunningham C, Soysal P, Isik AT, Luchini C, Solmi M, Sergi G, Manzato E, Veronese N.

Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes. Recently, interest has developed in hypovitaminosis D (defined as low 25 hydroxiyvitamin D levels) as a potential risk factor for orthostatic hypotension. We conducted a systematic review and meta-analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D, including the adjustment of potential confounders (age, sex, BMI, renal function, comorbidities, seasonality, use of antihypertensive medications, and supplementation with cholecalciferol).

A systematic literature search of major electronic databases from inception until 09/2015 was made for articles providing data on orthostatic hypotension and hypovitaminosis D. A random effects meta-analysis of cross-sectional studies investigating orthostatic hypotension prevalence comparing participants with vs. those without hypovitaminosis D was undertaken, calculating the odds ratios (ORs) and 95% confidence intervals (CIs).

Of 317 initial hits, five cross-sectional studies were meta-analysed including 3646 participants (1270 with hypovitaminosis D and 2376 without). The participants with hypovitaminosis D had a higher prevalence of orthostatic hypotension (OR = 1.88; 95% CI: 1.25-2.84; I = 68%) that was not affected by adjusting for a median of five potential confounders (OR = 2.03; 95% CI: 1.13-3.68; I = 73%). People with orthostatic hypotension had significantly reduced serum vitamin D concentrations (standardized mean difference = -0.42; 95% CI: -0.72 to -0.12). One longitudinal study confirmed the association between hypovitaminosis D and orthostatic hypotension.

Our meta-analysis highlights that hypovitaminosis D is associated with orthostatic hypotension, independent of potential confounders. Further longitudinal studies and clinical trials are required to confirm these findings.

Vitamin D Deficiency and Incident Onset of Orthostatic Hypotension in Older Adults: Preliminary Results from the ‘MERE’ Study - June 2015

Journal of the American Geriatrics Society. Volume 63, Issue 6, pages 1245–1247, June 2015, DOI: 10.1111/jgs.13504
Guillaume T. Duval MD1, Antoine Brangier MD1, Jean Barré MD1, Cyrille P. Launay MD, MS1, Olivier Beauchet MD, PhD1,2 and Cedric Annweiler MD, PhD1,2,3

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Orthostatic hypotension 3.4 X more likely in elderly if low Vitamin D - Sept 2014

Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women
J Intern Med. 2014 Sep;276(3):285-95. doi: 10.1111/joim.12201. Epub 2014 Apr 22.
Annweiler C1, Schott AM, Rolland Y, Beauchet O.

OBJECTIVES: 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.

DESIGN: Cross-sectional analysis at baseline of the EPIDOS study.

SETTING: Five French areas.

PARTICIPANTS: 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(-1) . 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.

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 β = -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).

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.

PMID: 24444004 DOI: 10.1111/joim.12201

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