Resumen de Impaired Orthostatic Blood Pressure Recovery Is Associated with Unexplained and Injurious Falls

Ciaran Finucane, Matthew D.L. O'Connell, Orna Donoghue, Kathryn Richardson, George M. Savva, Rose Anne Kenny

• Objectives Cardiovascular disorders are recognized as important modifiable risk factors for falls. However, the association between falls and orthostatic hypotension (OH) remains ambivalent, particularly because of poor measurement methods of previous studies. The goal was to determine for the first time to what extent OH (and variants) are risk factors for incident falls, unexplained falls (UF), injurious falls (IF) and syncope using dynamic blood pressure (BP) measurements in a population study.

  Design Nationally representative longitudinal cohort study–The Irish Longitudinal Study on Ageing (TILDA)–wave 1 (2009–2011) with 2-year follow-up at wave 2 (2012–2013).

  Setting Community-dwelling adults.

  Participants Four thousand one hundred twenty-seven participants were randomly sampled from the population of older adults aged ≥50 years resident in Ireland.

  Measurements Continuous BP recordings measured during active stands were analyzed. OH and variants (initial OH and impaired orthostatic BP stabilization OH(40)) were defined using dynamic BP measurements. Associations with the number of falls, UF, IF, and syncope reported 2 years later were assessed using negative binomial and modified Poisson regression as appropriate.

  Results Participants had a mean age of 61.5 (8.2) years (54.2% female). OH(40) was associated with increased relative risk of UF (RR: 1.52 95% CI: 1.03–2.26). OH was associated with all-cause falls (IRR: 1.40 95% CI: 1.01–1.96), UF(RR: 1.81 95% CI: 1.06–3.09), and IF(RR: 1.58 95% CI: 1.12–2.24). IOH was not associated with any outcome.

  Conclusion With the exception of initial orthostatic hypotension, beat-to-beat measures of impaired orthostatic BP recovery (delayed recovery OH (40) or sustained orthostatic hypotension OH) are independent risk factors for future falls, unexplained falls, and injurious falls.