Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract

Background Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. Methods Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. Results One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14–20%; I2 = 99%) for 34 community cohorts, 19% (15–25%; I2 = 98%) for 23 primary care cohorts and 31% (15–50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16–23%; I2 = 98%) with hypertension (20 cohorts), 21% (16–26%; I2 = 92%) with diabetes (4 cohorts), 25% (18–33%; I2 = 88%) with Parkinson’s disease (7 cohorts) and 29% (25–33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12–17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04). Conclusions PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO:CRD42017075423.

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

“…Advantages of telehealth identified before and during the pandemic include improved access, remote triage of patients, routine follow-up care (especially for managing chronic conditions), remote diagnosis and remote patient care ( Breton et al 2021 ; Kichloo et al 2020 ; Smith et al 2020 ; Srinivasan et al 2020 ; Wijesooriya et al 2020 ). Disadvantages relate mainly to changes in the therapeutic relationship, which make it more difficult to establish trust and can depersonalize care ( Bergman et al 2020 ; Shankar et al 2020 ; Srinivasan et al 2020 ).…”

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“…Healthcare professionals participating in this study emphasized the importance of patients’ possession of health literacy and communication skills, which allows them to participate in PCC delivery. The alignment of information provided with multimorbid patients’ needs and backgrounds has been shown to be important to increase patient-centeredness [ 34 ]. This study revealed wide variation in such literacy and skills among patients with multimorbidity.…”

“…They reported that adequate information sharing is difficult to achieve when working with large teams of healthcare professionals across multiple settings. A study investigating how GP practices should organize their care for patients with multimorbidity to increase patient-centeredness showed that multidisciplinary work is very important and can be strengthened by the organization of multidisciplinary meetings [ 34 ]. A systematic review showed that fragmentation between primary and secondary care poses a major challenge to the provision of care to patients with multimorbidity [ 40 ].…”

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“…Although a clear vision of PCC for patients with multimorbidity has been developed [ 34 ], PCC implementation in practice is not always straightforward. Barriers occasionally hamper adequate PCC delivery or prevent PCC implementation entirely.…”