Orthostatic Hypotension in Middle-Age and Risk of Falls

Abstract

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.

Hypertension Treatment and Control and Risk of Falls in Older Women

“…[26][27][28] Juraschek et al reported that orthostatic hypotension in middle-aged adults was positively associated with falls, fractures, and syncope during a median of 23 years of followup. 29 Finucane et al also found a 40% increased risk of falls at 2 years of follow-up in people with orthostatic hypotension in a population-based prospective study in Irish adults. 30 The SPRINT study also supported this finding, 31 as did smaller and cross-sectional studies, 28,32 although one moderately large prospective study did not.…”

“…Orthostatic hypotension (a drop in BP on standing), which becomes more prevalent with aging and is more common in individuals with hypertension, might be another link between antihypertensive treatment and falls . Juraschek et al reported that orthostatic hypotension in middle‐aged adults was positively associated with falls, fractures, and syncope during a median of 23 years of follow‐up . Finucane et al also found a 40% increased risk of falls at 2 years of follow‐up in people with orthostatic hypotension in a population‐based prospective study in Irish adults .…”

Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body Composition Study

“…Precise measures of postural hypotension using beat-to-beat blood pressure monitoring techniques have recently provided unique insight into the relationship between postural hypotension and falls. 16,17 Future work examining nerve conduction velocity and continuous beat-to-beat monitoring assessments of postural hypotension may be an important extension of this work, particularly as both have been related to falls in older adults. 9,12,16–18 Two of our measures of cardiovascular autonomic function were dependent on completing a 400m endurance walking test—the Long Distance Corridor Walk.…”

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

“…Covariates were selected a priori to examine the independent association between OH and CVD 28, 29, 31. We specifically examined established cardiovascular risk factors on the basis of demographic information, self‐reported behaviors, body mass index, cholesterol, and comorbid conditions (diabetes mellitus, hypertension, and chronic kidney disease).…”