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.