Delayed Blood Pressure Recovery After Standing Independently Predicts Fracture in Community-Dwelling Older People.

Orthostatic hypotension, characterized by delayed blood pressure (BP) recovery after standing, is a risk factor for falls but the longitudinal relationship with fracture is not yet known. The aim of this study was to examine the prospective risk of fracture associated with delayed BP recovery. Longitudinal study with 8-year follow-up. More than 3000 (54% female) community-dwelling people aged ≥50 years from a large longitudinal study on ageing. Orthostatic BP was measured using a finometer when standing from lying. Delayed BP recovery was defined as systolic BP ≥20 mm Hg lower and/or diastolic BP ≥10 mm Hg from the baseline value at 30, 60, and 90 seconds after standing. Participants with a fracture reported at any of waves 2 to 5 were defined as having incident fracture. Logistic regression models were used to estimate odds ratios (ORs) for the association between delayed BP recovery and incident fracture. Seven percent (212/3117) of participants sustained a fracture during follow-up. Delayed BP recovery at 30 seconds was a significant predictor of any fracture [OR 1.80, 95% confidence interval (CI) 1.28-2.53] and hip fracture (OR 4.44, 95% CI 2.03-9.71) in fully adjusted models. Delayed BP recovery at 30 seconds did not predict wrist or vertebral fracture. Delayed BP recovery at 60 seconds also predicted any fracture (OR 1.74, 95% CI 1.19-2.54) and hip fracture (OR 4.66, 95% CI 2.12-10.26) whereas delayed BP recovery at 90 seconds predicted any (OR 1.99, 95% CI 1.38-2.87), wrist (OR 1.87, 95% CI 1.19-2.95), and hip fracture (OR 3.39, 95% CI 1.45-7.93) in fully adjusted models. and Implications: Delayed BP recovery independently predicts fracture in community-dwelling older people, is potentially modifiable, and can be measured in an ambulatory setting. Because of the morbidity and mortality associated with fractures, identification of such risk factors is crucial in order to inform preventative strategies.

Doyle K ，Lavan A ，Kenny RA ，Briggs R ... -  《-》

Asymptomatic orthostatic hypotension and risk of falls in community-dwelling older people.

Many older people with orthostatic hypotension (OH) may not report typical symptoms of dizziness, light-headedness or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Continuous orthostatic blood pressure (BP) was measured during active stand using a Finometer at Wave 1 of The Irish Longitudinal Study on Ageing in participants aged ≥ 70 years.OH, with and without dizziness, was defined as a sustained drop in systolic BP ≥ 20 and/or diastolic BP ≥ 10 mm Hg at 30, 60 and 90 seconds post-standing.The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Almost 11% (n = 934, mean age 75 years, 51% female) had OH, two-thirds of whom were asymptomatic.Dizziness was not associated with systolic BP drop at 30 (β = 1.54 (-1.27, 4.36); p = 0.256), 60 (β = 2.64 (-0.19, 5.47); p = 0.476) or 90 seconds (β = 2.02 (-0.91, 4.95); p = 0.176) after standing in adjusted models.Asymptomatic OH was independently associated with unexplained falls (odds ratio 2.01 [1.11, 3.65]; p = 0.022) but not explained falls (OR 0.93 [0.53, 1.62]; p = 0.797) during follow-up. Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

Claffey P ，Pérez-Denia L ，Lavan A ，Kenny RA ，Finucane C ，Briggs R ... -  《-》

What Is the Relationship Between Orthostatic Blood Pressure and Spatiotemporal Gait in Later Life?

Little work to date has examined the relationship between gait performance and blood pressure (BP) recovery after standing in later life. The aim of this study is to clarify the association of orthostatic BP with spatiotemporal gait parameters in a large cohort of older people. Cross-sectional study using multilevel linear regression to ascertain the difference in orthostatic BP patterns across tertiles of gait speed, and linear regression to analyze the association of orthostatic hypotension 30 seconds after standing (OH-30) with specific gait characteristics. The Irish Longitudinal Study on Ageing. A total of 4311 community-dwelling adults, aged 50 years or older (mean age = 62.2 years; 54% female), one fifth (n = 791) of whom had OH-30. Continuous orthostatic BP was measured during active stand. OH-30 was defined as a drop in systolic BP of 20 mm Hg or more or drop in diastolic BP of 10 mm Hg or more at 30 seconds. Spatiotemporal gait was assessed using the GAITRite system, reporting gait speed, step length, step width, and double support time in both single and dual (cognitive task) conditions. OH-30 was associated with slower gait speed (β = -3.01; 95% confidence interval [CI] = -4.46 to -1.56) and shorter step length (β = -.73; 95% CI = -1.29 to -.16) in fully adjusted models during single task walking. Similar findings were observed in dual task conditions, in addition to increased double support phase (β = .45; 95% CI = .02-.88). Multilevel models demonstrated that participants in the slowest tertile for gait speed had a significantly larger drop in systolic BP poststanding compared to those with faster gait speeds in single and dual task conditions. This study demonstrates that slower recovery of BP after standing is independently associated with poorer gait performance in community-dwelling older adults. Given the adverse outcomes independently associated with OH and gait problems in later life, increasing awareness that they commonly coexist is important, particularly as both are potentially modifiable. J Am Geriatr Soc 68:1286-1292, 2020.

Briggs R ，Donoghue OA ，Carey D ，O'Connell MDL ，Newman L ，Kenny RA ... -  《-》

Longitudinal Association Between Orthostatic Hypotension at 30 Seconds Post-Standing and Late-Life Depression.

There is an established cross-sectional association between orthostatic hypotension (OH) and late-life depression. The aim of this observational study was to clarify the longitudinal association between baseline symptomatic OH (sOH-30) and incident depression in a sample of >3000 older people without baseline depression (mean age: 62 years at baseline). This study was embedded within the Irish Longitudinal Study on Ageing using data from waves 1 to 3, collected between 2009 and 2014. At 2- and 4-year follow-up, a score ≥9 on the 8-item Center for Epidemiological Studies Depression Scale was used to define incident depression. sOH-30 was defined as a drop in systolic blood pressure ≥20 mm Hg or diastolic blood pressure ≥10 mm Hg at 30 seconds post-standing in conjunction with orthostatic symptoms, such as dizziness, using beat-to-beat measurements. Almost one fifth (proportion, 18%; 95% confidence interval [CI], 16-20) of the study sample had sOH-30. One tenth (proportion, 10%; 95% CI, 9-12) had incident depression. Participants with incident depression were twice as likely to have sOH-30 at baseline compared with those without incident depression (linear regression, 13% [95% CI, 8-19] versus 7% [95% CI, 6-8]). Weighted logistic regression models demonstrated that sOH-30 predicted incident depression with an odds ratio of 1.90 (95% CI, 1.15-3.15) after controlling for covariates, including subthreshold depression, hypotension, cognitive impairment, and antidepressant use. Asymptomatic OH at 30 seconds and initial OH did not predict depression. This study demonstrates that sOH-30 predicts incident depression in a population-representative sample of older people and may, therefore, represent a potentially modifiable risk factor for late-life depression.

Briggs R ，Carey D ，Kennelly SP ，Kenny RA ... -  《-》

The 'Bermuda Triangle' of orthostatic hypotension, cognitive impairment and reduced mobility: prospective associations with falls and fractures in The Irish Longitudinal Study on Ageing.

Orthostatic hypotension (OH), cognitive impairment (Cog) and mobility impairment (MI) frequently co-occur in older adults who fall. This study examines clustering of these three geriatric syndromes and ascertains their relationship with future falls/fractures in a large cohort of community-dwelling people ≥ 65 years during 8-year follow-up. OH was defined as an orthostatic drop ≥ 20 mmHg in systolic blood pressure (from seated to standing) and/or reporting orthostatic unsteadiness. CI was defined as Mini Mental State Examination ≤ 24 and/or self-reporting memory as fair/poor. MI was defined as Timed Up and Go ≥12 s. Logistic regression models, including three-way interactions, assessed the longitudinal association with future falls (explained and unexplained) and fractures. Almost 10% (88/2,108) of participants had all three Bermuda syndromes. One-fifth of participants had an unexplained fall during follow-up, whereas 1/10 had a fracture. There was a graded relationship with incident unexplained falls and fracture as the number of Bermuda syndromes accumulated. In fully adjusted models, the cluster of OH, CI and MI was most strongly associated with unexplained falls (odds ratios (OR) 4.33 (2.59-7.24); P < 0.001) and incident fracture (OR 2.51 (1.26-4.98); P = 0.045). Other clusters significantly associated with unexplained falls included OH; CI and MI; MI and OH; CI and OH. No other clusters were associated with fracture. The 'Bermuda Triangle' of OH, CI and MI was independently associated with future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.

Donnell DO ，Romero-Ortuno R ，Kennelly SP ，O'Neill D ，Donoghue PO ，Lavan A ，Cunningham C ，McElwaine P ，Kenny RA ，Briggs R ... -  《-》