Blood Pressure Associates with Standing Balance in Elderly Outpatients

Abstract

ObjectivesAssessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment.Materials and MethodsIn a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197) and continuously (subsample, n = 58) before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1) the ability to maintain standing balance; 2) self-reported impaired standing balance; and 3) history of falls, adjusted for age and sex.ResultsBlood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements.ConclusionContinuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.

Standing Up Slowly Antagonises Initial Blood Pressure Decrease in Older Adults with Orthostatic Hypotension

“…These results underline the importance of the use of continuous BP-measuring devices, which are the only means to assess iOH and are of great importance to the clinician to analyse the continuous BP response to orthostatic stress [6,14,15,19] . Patients with iOH are likely to have complaints of OH and a higher risk of falling [6] .…”

“…Supine BP increased after 3 periods of standing up without being compensated by the 5 min in supine rest, whereas communication and interaction with the patient was reduced to a minimum. We hypothesise that the supine BP rises after each standing up condition due to physical strain on the body and that 5 min rest in supine position is, although reported in the literature [15] , not sufficient in this group of patients. To the best of our knowledge, this effect has …”

“…The sample size was calculated based on an α of 0.05 and a β of 0.2, using a mean value of the drop of SBP after transition of 25 mm Hg, an expected mean value in the intervention group 'slow transition' of 15 mm Hg SBP and a standard deviation (SD) of 15 mm Hg as reported by Pasma et al [15] , resulting in 20 patients. Continuous variables with a normal distribution were presented as means and SD.…”

“…Complaints of orthostatic intolerance were defined as the presence of one or more symptoms including light-headedness, blurred vision, dizziness or instability during standing. To describe the patient's physical and cognitive condition, the body mass index, Short Physical Performance Battery (SPPB), hand grip strength in a standing position and Mini-Mental State Examination (MMSE) were used [15] .…”

The association between orthostatic hypotension, falling and successful rehabilitation in a nursing home population

“…Still, this is no explanation for the remarkable association. As OH is related to reduced standing balance (Pasma et al, 2014), the homes and home environment of patients with OH may be more adapted to their disabilities, or patients with OH may be used to a less active life, resulting in a quicker achievement of their rehabilitation targets. However, the Table 3 Cox regression analyses; hazard ratios for successful rehabilitation in the rehabilitation patient group (N = 128 Hazard ratios for successful rehabilitation.…”