Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA)

• Published in: PloS one 2021-05, Vol.16 (5), p.e0252212
• Main Authors: Donoghue, Orna A, O'Connell, Matthew D. L, Bourke, Robert, Kenny, Rose Anne
• Format: Article
• Language: English
• Subjects: Adults; Age; Aging; Biology and Life Sciences; Blood pressure; Codes; Cognitive ability; Complications and side effects; Computer programs; Data analysis; Data collection; Demographics; Demography; Drafting software; Editing; Environmental science; Fainting; Falls; Falls (Accidents); Funding; Health sciences; Heart; Hypertension; Hypotension; Hypotension, Orthostatic; Longitudinal studies; Medicine and Health Sciences; Methodology; Movement disorders; Neurodegenerative diseases; Older people; Orthostatic hypotension; Parkinson's disease; People and Places; Reviews; Risk factors; Sitting position; Social interactions; Software; Supine position; Syncope; Visualization
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252212

Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged [greater than or equal to]65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) [greater than or equal to]20 mmHg and/or [greater than or equal to]10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP [greater than or equal to]140 mm Hg or DBP [greater than or equal to]90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.