RESEARCH · November 11, 2014
TAKE-HOME MESSAGE
- The authors carried out a large population analysis to establish normal reference measures of orthostatic hypotension and study age-related changes. They analyzed the beat-to-beat systolic and diastolic BP and heart rate records of 4475 participants >50 years of age who were asked to undergo an active stand test. Orthostatic BP stabilized within 30 seconds of standing in the 50- to 59-years age group, but stabilization took longer in older participants. The overall prevalence of impaired BP stabilization (15.6%) increased with age, and was 41.2% in participants >80 years. OH prevalence was also higher in the older age group (18.5% for >80 years vs 6.9% in total population).
- The normative reference data for OH and impaired orthostatic BP were established. Nearly half of adults over 80 years are affected by OH and impaired orthostatic BP stabilization, which should be considered as a risk for falls.
ABSTRACT
BACKGROUND
In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample.
METHODS AND RESULTS
Participants were recruited from a nationally representative cohort study (≥50 years). Beat-to-beat systolic BP, diastolic BP, and heart rate records were analyzed among those who underwent an active stand test (n=4475). Normograms were estimated by use of generalized additive models for location, shape, and scale with Box-Cox power exponential distribution. Prevalence estimates of impaired BP stabilization, initial orthostatic hypotension, and orthostatic hypotension are reported. Orthostatic BP responses in adults aged 50 to 59 years stabilized within 30 seconds of standing, with older groups taking 30 seconds or longer. The total prevalence of impaired BP stabilization was 15.6% (95% confidence interval [CI], 14.1%-17.1%), increasing with age to 41.2% (95% CI, 30.0%-52.4%) in people ≥80 years old. Initial orthostatic hypotension occurred in 32.9% (95% CI, 31.2%-34.6%) of the population aged ≥50 years, with no age gradient evident. The prevalence of orthostatic hypotension was 6.9% (95% CI, 5.9%-7.8%) in the total population, increasing to 18.5% (95% CI, 9.0%-28.0%) in those aged ≥80 years old.
CONCLUSIONS
Significant age-related differences exist in the time course of postural BP responses, with abnormal responses taking longer than 30 seconds to stabilize. Impaired BP stabilization is more common as we age, affecting more than two-fifths of the population aged ≥80 years, and may play a future role in the management of falls and syncope.
Circulation
Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study: Findings From The Irish Longitudinal Study on Ageing (TILDA)