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

Abstract

<b><i>Background:</i></b> Orthostatic hypotension (OH) and impaired OH recovery derived from beat-to-beat blood pressure (BP) measurements are associated with detrimental clinical outcome, but the clinical relevance of OH recovery assessed using the widely available sphygmomanometer is still unclear. <b><i>Method:</i></b> 635 geriatric outpatients underwent comprehensive geriatric assessment, including orthostatic BP measurements using a sphygmomanometer, during supine rest and 1 and 3 min after standing up and assessment of physical performance (i.e., the timed up and go test and the Short Physical Performance Battery) and the number of falls in the past year. The association between BP recovery, defined as BP at 3 min minus BP at 1 min after standing up, with physical performance and falls was assessed using regression analyses, adjusting for age and sex, both in the entire cohort and after stratifying for the presence of OH at 1 min after standing up. <b><i>Results:</i></b> BP recovery was not associated with physical performance or number of falls, neither in the entire cohort, nor in subpopulations with or without OH. <b><i>Conclusion:</i></b> The clinical relevance of BP recovery between 1 and 3 min after standing up could not be demonstrated. The results suggest that sphygmomanometer measurements have an inadequate time resolution to record the clinically relevant dynamics of orthostatic BP recovery.

The impact of cardiovascular diagnostics and treatments on fall risk in older adults: a scoping review and evidence map

“…We included one systematic review and meta-analysis [ 37 ] and 16 original studies [ 38 – 53 ] on (orthostatic) blood pressure measurements in fallers. In the systematic review and meta-analysis by Mol et al [ 37 ], the relevance of blood pressure measurement methodology in OH-related falls was demonstrated.…”

“…Intermittent (sphygmomanometer) blood pressure measurements during AS were used in four (4/16) studies [ 48 , 50 , 52 , 53 ]. In one study [ 50 ], prevalence of OH was higher at the 30s measurement compared to the 3 min measurement.…”

“…Authors concluded that the 30-s measurement was more reliable to detect fall risk. Another study [ 53 ] did not find an association between BP recovery (BP at 3 min minus BP at 1 minute after standing) and number of falls in the past year, suggesting that sphygmomanometer measurements have inadequate time resolution to record clinical relevant dynamics of orthostatic BP recovery. Another study [ 52 ], compared seated-to-standing measurements to supine-to-standing measurements.…”

“…In addition to existing guidelines and reviews, our review adds that using the 5-s average in continuous blood pressure measurements (Finometer device) needs to be considered [ 42 ]. Also, recognizing BP patterns and BP drop rate during the continuously measured orthostatic AS test could assist clinicians in guiding clinical fall risk assessment [ 51 , 53 ]. However, the exact role of these characteristics needs to be further established in future studies.…”

Cardiovascular Disorders and Falls Among Older Adults: A Systematic Review and Meta-Analysis

“…Of 13 studies that utilized sphygmomanometers, but did not specify which type, 6 reported a positive association: QA 6.8 (range 5–9) ( 36 , 145 , 147 , 150 , 151 , 153 ). Seven reported no association: QA 7.5 (range 4–9) ( 43 , 60 , 122 , 146 , 148 , 149 , 152 ).…”