Orthostatic blood pressure recovery associates with physical performance, frailty and number of falls in geriatric outpatients

Abstract

Objective: Blood pressure (BP) recovery after orthostatic hypotension might be important to prevent cerebral hypoperfusion episodes in older adults, and be related to better clinical outcome. The objective was to study the relationship between BP recovery and clinical outcome, that is physical and cognitive performance, frailty and falls, in geriatric outpatients. Methods: One hundred and sixty-eight geriatric outpatients underwent continuous (beat-to-beat) BP measurements during standing up, and a comprehensive geriatric assessment, including assessment of physical performance (chair stand test), cognitive performance (Mini Mental State Examination), frailty (Fried criteria) and falls in the previous year. BP recovery was evaluated at 15–30, 30–60, 60–120 and 120–180 s after standing up and defined as mean SBP and DBP in the respective time intervals minus baseline BP. Associations with clinical outcome were assessed using linear (physical and cognitive performance and frailty) and logistic (falls) regression, adjusting for age, sex, baseline BP and initial BP drop. Results: SBP recovery was associated with frailty (30–60 s interval; β = 0.013, P = 0.02) and falls (30–60 s interval; odds ratio = 1.024, P = 0.02). DBP recovery was associated with physical performance (30–60 s interval; β = 0.215, P = 0.01), frailty (30–60 s interval; β = 0.028, P = 0.02) and falls (30–60 s interval; odds ratio = 1.039, P = 0.04). Neither SBP nor DBP recovery was associated with cognitive performance. Conclusion: DBP recovery was particularly associated with clinical outcome in geriatric outpatients, suggesting BP recovery to be of clinical interest.

Orthostatic Blood Pressure Recovery Measured Using a Sphygmomanometer Is Not Associated with Physical Performance or Number of Falls in Geriatric Outpatients

“…BP recovery between 1 and 3 min after standing up measured with a sphygmomanometer was not associated with physical performance or number of falls in a large population of geriatric outpatients. The present results point in a different direction than previous studies, which used continuous BP measurements and reported BP recovery between 30 and 60 s after standing up to be associated with impaired physical performance, frailty, and falls [9, 11]. Patients may be particularly vulnerable for inadequate BP recovery in this time window as cerebral autoregulation might not have reached its full capacity [19].…”

“…Previous studies used a number of different BP recovery measures derived from continuous (beat-to-beat) BP measurements during and after standing up and found a lower BP recovery to be associated with physical performance, frailty, falls, and cognitive decline [8-11] but not with mortality [12-14]. However, continuous BP measurements are most often not available in clinical practice, in contrast to intermittent (sphygmomanometer) BP measurements.…”

Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees

“…These results extend our previous population-based work on probable sarcopenia [ 16 ] and, to the best of our knowledge, show for the first time an association between confirmed sarcopenia and delayed BP recovery using continuous non-invasive orthostatic haemodynamic measurements. Findings are clinically important as even in the absence of OH at 30 s, delayed BP recovery in the early post-standing phase can contribute to reduced cerebral perfusion and increase the risk of falls and syncope [ 8 , 28 , 29 ], which in turn can lead to fractures, hospital admissions, loss of functional independence, and risk of institutionalisation [ 9 , 30 ]. Although sarcopenia can directly lead to falls [ 31 ], our results suggest the existence of an indirect mechanism whereby sarcopenia could also contribute to falls by impairing early post-standing BP recovery.…”

Diagnosis and treatment of orthostatic hypotension

“…57 Substantially more evidence comes from population-based studies on classic orthostatic hypotension and delayed blood pressure recovery patterns measured with traditional upper arm sphygmomanometers. Multiple large, prospective cohort studies of community-dwelling adults have shown that both delayed blood pressure recovery and classic orthostatic hypotension are associated with future risk of adverse health outcomes, including frailty, 47,58 falls, 5,20,21,47,58-61 frac tures, 41,59,62 syncope, 41 cognitive decline and demen tia, 61,63,64 depression, 65 stroke, 63,64,66,67 cardiovas cular disease, 66,68 and early death. 4,5,41,69 One study showed that early orthostatic hypotension (applying classic ortho static hypotension criteria within 1 min of standing) was more strongly related to individual long-term risks than later orthostatic hypotension (applying criteria in the 1-3 min range).…”