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)

Abstract

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 ≥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) ≥20 mmHg and/or ≥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 ≥140 mm Hg or DBP ≥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.

Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021

“…TILDA (The Irish Longitudinal Study on Ageing) of 1500 community-dwelling adults found that orthostasis with coexisting hypertension either in the seated/supine position was significantly associated with a higher risk of falls and syncope, although the effect size was notably larger for seated compared to supine hypertension. 40 Studies of patients with autonomic dysfunction have found that those with supine hypertension had worse renal function, higher rates of left ventricular hypertrophy, and earlier incidence of CVD and all-cause mortality than those without supine hypertension. 41,42…”

New horizons in the ageing autonomic nervous system: orthostatic hypotension and supine hypertension

“…OH is an adverse prognostic sign for poor outcome across a wide range of conditions: most immediately it is associated with increased risk of falls, syncope and injury [ 5 , 6 , 34 ]. However, it is also associated with cardiac disease including changes in carotid intimal thickness, increased carotid plaque, elevated cardiac injury biomarkers [ 35 ] heart failure, coronary artery disease, atrial fibrillation, chronic kidney disease and stroke [ 36–39 ].…”

Comparison of Gait Speed Reserve, Usual Gait Speed, and Maximum Gait Speed of Adults Aged 50+ in Ireland Using Explainable Machine Learning

“…During the TILDA Wave 3 health assessment, resting-state (RS) cardiovascular measurements were made during an approximately 10-min window in which the participant was lying supine in a comfortably lit room at an ambient temperature of between 21 °C and 23 °C. The full TILDA active stand protocol in which the resting-state window takes place has been detailed elsewhere (Finucane et al, 2014;Knight et al, 2020;Donoghue et al, 2021). Throughout the RS, participants underwent non-invasive continuous haemodynamic monitoring using a Finometer MIDI device (Finapres Medical Systems BV, Amsterdam, Netherlands).…”

“…UGS is a commonly measured gait characteristic in clinical practice and has well-established associations with age (Samson et al, 2001), physical function (James et al, 2020), and frailty (O' Donoghue et al, 2021). On the other hand, MGS has been associated with physical and cognitive function (Umegaki et al, 2018;Aldridge et al, 2020).…”