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J Am Geriatr Soc. 2011 Apr;59(4):655-65. doi: 10.1111/j.1532-5415.2011.03352.x. Epub 2011 Mar 25.

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

Author information

  • 1Technology Research for Independent Living Centre, Trinity College, Dublin, Ireland. romeror@tcd.ie

Abstract

OBJECTIVES:

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).

DESIGN:

Cross-sectional.

SETTING:

Geriatric research clinic.

PARTICIPANTS:

Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy.

MEASUREMENTS:

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).

RESULTS:

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).

CONCLUSION:

It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people.

© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

PMID:
21438868
[PubMed - indexed for MEDLINE]
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