CQ18: What is the relationship of frailty with orthostatic hypotension and orthostatic intolerance? Summary • Orthostatic hypotension and orthostatic intolerance are more prevalent among frail individuals than non-frail individuals, and these conditions worsen frailty outcomes (evidence level: E-2).
ExplanationOrthostatic hypotension and orthostatic intolerance, both of which are risk factors for falls, are reported to be associated with frailty. O'Connell et al. examined the relationship between orthostatic hypotension, orthostatic intolerance and frailty using data from 5692 individuals aged ≥50 years who participated in the Irish Longitudinal Study on Aging (TILDA). Of these participants, 6.1% had orthostatic hypotension, 6.7% had orthostatic intolerance and 4.3% were identified as frail, and 34.5% participants were identified as pre-frail under the Cardiovascular Health Study (CHS) criteria. Both orthostatic hypotension and orthostatic intolerance were more prevalent in frail participants (8.9% and 14.3%) than they were in robust participants (5.0% and 5.7%). In a multivariate analysis, orthostatic intolerance was found to be independently associated with frailty (odds ratio [OR] 1.80, 95% CI 1.13-2.87), although orthostatic hypotension was not. 1 Similarly, Freud et al. examined associations between orthostatic hypotension and mortality using data of patients who were regularly assessed in the outpatient Comprehensive Geriatric Assessment Unit. These patients were aged ≥65 years (mean age 83.7 years), and 32.1% were diagnosed with orthostatic hypotension. They found that orthostatic hypotension was associated with increased mortality (over the follow-up period, 30.2% and 22.3% of those with and without orthostatic hypotension died, respectively), but a multivariate analysis did not show orthostatic hypotension to be independently associated with increased mortality. 2 These studies suggest that orthostatic hypotension and orthostatic intolerance are more prevalent in frail individuals, and that they worsen frailty outcomes.Romero-Ortuno et al. analyzed a sample of older individuals (average age of 72, 6.1% with orthostatic hypotension, 6.7% with orthostatic intolerance) who did not have dementia or risk factors for autonomic neuropathy. They arranged the participants into non-frail, pre-frail and frail groups, and found that the baseline heart rate decreased across the groups in that order. They also found that the delta heart rate (maximum heart rate within 30 s after standing minus baseline heart rate) increased across the groups in that order. It was reported that 30 s after standing, 98% of the non-frail participants, 95% of the pre-frail participants and 92% of the frail participants recovered to their baseline heart rate. 3 These findings suggest that frailty worsens hypostatic problems that occur when standing.CQ19: What is the relationship of frailty with antihypertensive treatment? Summary • Antihypertensive treatment prevents cardiovascular events whether or not the patient is frail. Intensive anti...