Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community-Dwelling Elderly Population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study

Gangavati, Anupama; Hajjar, Ihab; Quach, Lien; Jones, Richard N.; Kiely, Dan K.; Gagnon, Peggy; Lipsitz, Lewis A.

doi:10.1111/j.1532-5415.2011.03317.x

Cited by 271 publications

(215 citation statements)

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“…25 However, prospective studies examining this relationship are small, of short duration, and inconsistent with some showing OH to be associated with risk of falls [26][27][28][29][30] and others showing no association. [31][32][33][34][35][36][37][38] One of the larger prospective studies, conducted in 844 nursing home residents, reported that OH was associated with a higher risk of falls (relative risk: 2.1, 95% CI: 1.4, 3.1) during 1.2 years of follow-up. 26 In contrast, a larger prospective study of 1,517 ambulatory Chinese patients, showed that OH was not associated with falls after adjustment for other risk factors.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension in Middle-Age and Risk of Falls

Juraschek

Daya

Appel

et al. 2016

AJHYPE

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Falls are a major cause of morbidity and mortality among older adults. 1,2 Nearly, one-third of persons aged 65 or older falls each year and the rate of falls in the United States is rising. 1,2 Moreover, falls are a significant reason for emergency room visits 3 and predispose to the risk of fracture, 4 posing a substantial burden on the US health system, estimated at approximately $23 billion yearly. 5 Given the aging US population, identifying risk factors for falls and tailoring interventions (e.g., physical therapy, prescription medication choices, or environment-based interventions like handrails) to prevent falls are recognized public health priorities.Orthostatic hypotension (OH) is a controversial risk factor for falls that has important implications for clinical guidelines on blood pressure management. The recently published SPRINT trial suggested that more intensive blood pressure management was associated with a lower risk of OH, but not a decreased risk of injurious falls. 6 OH has been traditionally thought to disproportionately impact older adults. The prevalence of OH increases with age, 7 reaching as high as 20% in adults age 75 years and older. 8 Furthermore, OH is associated with a history of falls as well as greater morbidity from falls in older adults. [8][9][10] Despite the focus in the literature on older adults, OH is also quite prevalent among middle-aged adults (as high as 15.9% in 1 study 11 ), who have a notably lower fall rate. While in the short-term, middle-aged OH may not be a major contributor to risk of serious falls, it is unknown whether it might be associated with risk of falls over time as people age.Thus, the aims of this prospective study were to: (i) determine whether OH in middle age was associated with risk of falls over the lifespan; (ii) characterize the continuous relationship between postural changes in systolic blood pressure (SBP) or diastolic blood pressure (DBP) and fall risk; and (iii) identify whether participant demographic characteristics or cardiovascular risk factors (obesity, hypertension, or diabetes) modified the association between OH and falls. We hypothesized that OH would be significantly associated with falls and this association would be more pronounced among older persons with cardiovascular risk factors. Orthostatic Hypotension in BACKGROUNDOne-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent.

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Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension in Middle-Age and Risk of Falls

Juraschek

Daya

Appel

et al. 2016

AJHYPE

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“…Although some studies demonstrated that OH is associated with adverse events, including myocardial infarction, coronary artery disease, incident heart failure, recurrent falls, overall and cardiovascular death [2,4,10,11,[19][20][21][22], several other studies have reported negative results [4,6,9,10,19,[23][24][25]. However, most of these studies have been performed on selected samples of subjects, mainly on community-dwelling hypertensive or diabetic individuals with few other co morbidities.…”

Section: Introductionmentioning

confidence: 94%

Prevalence and Clinical Implications of Orthostatic Hypotension in Elderly Inpatients

Brescianini¹

2013

J Hypertens

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“…73 Orthostatic hypotension is not only associated with mortality and cardiovascular outcomes but has also been linked to falls and cognitive impairment. 41,74 Although the relation between orthostatic hypotension and fall risk has been shown in several studies, [74][75][76][77] studies on the relation between orthostatic hypotension and cognitive impairment are less consistent and causality is unclear. 41,78 Also, whether there are differences between symptomatic and asymptomatic orthostatic hypotension with respect to risk of functional impairment is unknown and warrants further research.…”

Section: Risk Of Functional Disabilitiesmentioning

confidence: 99%

Treatment of Hypertension in the Oldest Old

et al. 2014

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A n 88-year-old woman with chronic hypertension was seen in the internal/geriatric medicine outpatient clinic. She had been treated for high blood pressure (BP) for ≈20 years with a low-dose thiazide, to which an angiotensin-converting enzyme-inhibitor had been added 5 years ago. In addition, after a possible transient ischemic attack 10 years ago, aspirin, omeprazole, and simvastatin had been added. She is known with mild cognitive impairment, which is stable with a mini-mental state examination score of 25, and a mild depression for which fluoxetine has been prescribed. In addition, she experienced 2 falls in the past 2 years; calcium/vitamin D and alendronate were started for the management of osteoporosis. On physical examination, she appears vital with a normal fluent gait and no signs of hemiparesis. Her BP is 165/75 mm Hg in the sitting position. Immediately after standing up from her chair, she feels dizzy for ≈10 seconds, but after 1 and 3 minutes, no orthostatic hypotension is found. Estimated glomerular filtration rate is 50 mL/min per 1.73 m 2 . Should antihypertensive treatment be intensified, left unaltered, or reduced?The oldest old, that is, persons aged ≥80 years, will be the fastest growing segment of the population for the next 40 years. By 2050, more than one quarter of all men and women aged ≥65 years in the Western world will be in the oldest old group. 1Despite longer life expectancy, the prevalence of various chronic diseases and functional impairment increases with age. As a result, populations of older individuals are often highly heterogeneous and individuals with same chronological age vary widely in health and functional ability. In other words, there is substantial heterogeneity in their biological age, and those at the higher end of biological age are often referred to as vulnerable or frail.BP rises with age, and ≈80% of people in Western societies aged ≥80 years have hypertension.2 Their hypertension is commonly characterized by elevated systolic BP, with often normal or even low diastolic BP. The widened pulse pressure (PP) is a reflection of increased arterial stiffness. Despite the large body of evidence in middle-aged populations, the predictive value of high BP in this rapidly growing older population is still debated, as is the question of whether hypertension should be treated, and if so, how intensively. Importantly, the current paradigm of lower is better may not apply to (untreated or treated) BP in the oldest old.In this concise narrative review, we summarize evidence from observational studies and randomized clinical trials. We conclude that biological age/frailty is becoming an important criterion for treatment decisions. Finally, we address what we think are the most pressing research questions for the coming years. Pathophysiology of BP Regulation in the Oldest OldAlthough hypertension in the oldest old may reflect a longstanding condition, often it manifests itself as a de novo abnormality. Data from the Framingham Heart Study indicate that the majority of patient...

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Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community-Dwelling Elderly Population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study

Cited by 271 publications

References 27 publications

Orthostatic Hypotension in Middle-Age and Risk of Falls

Orthostatic Hypotension in Middle-Age and Risk of Falls

Prevalence and Clinical Implications of Orthostatic Hypotension in Elderly Inpatients

Treatment of Hypertension in the Oldest Old

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