Orthostatic hypotension, orthostatic intolerance and frailty: The Irish Longitudinal Study on Aging-TILDA.

Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). This study was based on a cross-sectional analysis of 5692 community dwelling adults aged 50 years and older included in wave 1 of the Irish Longitudinal Study on Aging. Frailty was assessed using both the phenotypic (FP) and frailty index (FI) models. OH was defined as a drop of ≥20 mmHg in systolic blood pressure or a drop of ≥10 mmHg diastolic pressure on standing from a seated position. OI was defined as reporting feeling dizzy, light headed or unsteady during this test. 346 (6.1%) participants had OH and 381 (6.7%) participants had OI. The prevalence OH in frail participants was 8.9%, compared to 5% in robust. Similarly the prevalence of OI was 14.3% in frail and 5.7% in robust participants. After adjustment for age and gender, OH was not significantly related to the FP (OR=1.10 95% CI=0.67, 1.81). Conversely OI was (OR=1.80 95% CI=1.13, 2.87), even after adjustment for age, gender, cardiovascular factors and mental health. In fully adjusted models OI remained related to slowness and low muscle strength and to higher FI scores. These data suggest OI symptoms in older adults may reflect various important underlying health deficits, indicative of increasing levels of frailty. Further assessment of frailty in patients experiencing OI is a potential opportunity for early intervention to delay functional decline.

O'Connell MD ，Savva GM ，Fan CW ，Kenny RA ... -  《-》

Insights into the clinical management of the syndrome of supine hypertension--orthostatic hypotension (SH-OH): the Irish Longitudinal Study on Ageing (TILDA).

Romero-Ortuno R ，O'Connell MD ，Finucane C ，Soraghan C ，Fan CW ，Kenny RA ... -  《BMC Geriatrics》

Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.

To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). Cross-sectional. Geriatric research clinic. Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. Active lying-to-standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline - nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5-second averages method and entered in K-means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH- (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH- (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005). It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people.

Romero-Ortuno R ，Cogan L ，Foran T ，Kenny RA ，Fan CW ... -  《-》

Is orthostatic hypotension more common in individuals with atrial fibrillation?-Findings from The Irish Longitudinal Study on Ageing (TILDA).

atrial fibrillation (AF) and orthostatic hypotension (OH) share common risk factors such as age, hypertension and cardiovascular (CV) disease. The autonomic nervous system (ANS) also plays a role in the pathogenesis of both AF and OH. The aim of this study is to assess whether individuals with AF are more likely to have OH than those without AF. data from wave 1 of The Irish Longitudinal Study on Ageing were used. Beat-to-beat blood pressure was measured during active stand lasting 110 s. OH, defined as a drop in systolic blood pressure (SBP) ≥20 mmHg or a drop in diastolic blood pressure ≥10 mmHg at 30, 60 and 90 s was assessed. Initial OH (IOH) was assessed as a drop in SBP ≥40 mmHg or a drop in diastolic BP≥20 mmHg. in total 4,408 participants aged ≥50 had active stand and electrocardiogram data suitable for analysis. AF was identified in 101 of these. Logistic regression found participants with AF were more likely to have OH at 30 (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.24-3.06) and 60 (OR 2.13, 95% CI 1.18-3.87) seconds, and IOH (OR 1.81, 95% CI 1.21-2.70). The association between IOH and OH at 30 s remained significant following adjustment for confounders (age, sex, baseline HR, education, BP, smoking, frailty, beta blocker (BB) use, anti-hypertensive use (excluding BBs) and number of CV conditions). OH is more common in individuals with AF, this may reflect the role of the ANS in both AF and OH.

McNicholas T ，Tobin K ，O'Callaghan S ，Kenny RA ... -  《-》

Impairments in Hemodynamic Responses to Orthostasis Associated with Frailty: Results from The Irish Longitudinal Study on Ageing (TILDA).

To characterize the relationships between orthostatic blood pressure (BP) and heart rate recovery and frailty in an older population. Cross-sectional study. Two health centers in the Republic of Ireland. The Irish Longitudinal Study on Ageing participants aged 50 and older (N=4,334). Continuous noninvasive BP responses during active standing were captured using digital photoplethysmography. Frailty was assessed using the Cardiovascular Health Study criteria. Linear mixed models (random intercept) with piecewise splines were used to model differences in rate of BP and heart rate recovery. Ninety-three (2.2%) participants were frail, and 1,366 (31.5%) were prefrail. Adjusting for age and sex, frailty was associated with a slower rate of systolic BP recovery 10 to 20 seconds after standing (frailty by time = -4.12, 95% confidence interval=-5.53 to -2.72) and with subsequent deficits in BP 20 to 50 seconds after standing. Similar results were seen for diastolic BP and heart rate. Further adjustment for health behaviors, morbidities, and medications reduced, but did not attenuate, these associations. Of the 5 frailty criteria, only slow gait speed was consistently related to impaired BP and heart rate responses in the full model. Frailty, particularly slow gait speed, was associated with slower rate of BP and heart rate recovery after active standing. Impaired BP recovery may be a marker of physiological frailty.

O'Connell MD ，Savva GM ，Finucane C ，Romero-Ortuno R ，Fan CW ，Kenny RA ... -  《-》