Continuous Noninvasive Orthostatic Blood Pressure Measurements and Their Relationship with Orthostatic Intolerance, Falls, and Frailty in Older People

OBJECTIVES: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypoten...

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Published in:Journal of the American Geriatrics Society (JAGS) 2011-04, Vol.59 (4), p.655-665
Main Authors: Romero-Ortuno, Roman, Cogan, Lisa, Foran, Tim, Kenny, Rose Anne, Fan, Chie Wei
Format: Article
Language:English
Subjects:
Accidental Falls - statistics & numerical data
Aged
Arterial hypertension. Arterial hypotension
Biological and medical sciences
Blood and lymphatic vessels
Blood pressure
Blood Pressure - physiology
Blood Pressure Monitoring, Ambulatory - methods
Cardiology. Vascular system
Clinical manifestations. Epidemiology. Investigative techniques. Etiology
Cluster Analysis
consensus
Cross-Sectional Studies
Falls
Female
Finometer
Frail Elderly
Frailty
General aspects
Humans
hypotension
Male
Medical sciences
Middle Aged
Miscellaneous
Older people
orthostatic
orthostatic intolerance
Orthostatic Intolerance - physiopathology
Posture - physiology
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
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Summary:OBJECTIVES: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). DESIGN: Cross‐sectional. SETTING: Geriatric research clinic. PARTICIPANTS: Four hundred forty‐two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. MEASUREMENTS: Active lying‐to‐standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline – nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5‐second averages method and entered in K‐means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). RESULTS: The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P
ISSN:0002-8614
1532-5415
DOI:10.1111/j.1532-5415.2011.03352.x