Continuous Noninvasive Orthostatic Blood Pressure Measurements and Their Relationship with Orthostatic Intolerance, Falls, and Frailty in Older People
Article first published online: 25 MAR 2011
© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 59, Issue 4, pages 655–665, April 2011
How to Cite
Romero-Ortuno, R., Cogan, L., Foran, T., Kenny, R. A. and Fan, C. W. (2011), Continuous Noninvasive Orthostatic Blood Pressure Measurements and Their Relationship with Orthostatic Intolerance, Falls, and Frailty in Older People. Journal of the American Geriatrics Society, 59: 655–665. doi: 10.1111/j.1532-5415.2011.03352.x
- Issue published online: 14 APR 2011
- Article first published online: 25 MAR 2011
- orthostatic intolerance;
- cluster analysis;
- frail elderly;
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).
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.