TY - JOUR
T1 - Orthostatic Hypotension in Middle-Age and Risk of Falls
AU - Juraschek, Stephen P.
AU - Daya, Natalie
AU - Appel, Lawrence J.
AU - Miller, Edgar R.
AU - Windham, Beverly Gwen
AU - Pompeii, Lisa
AU - Griswold, Michael E.
AU - Kucharska-Newton, Anna
AU - Selvin, Elizabeth
N1 - Publisher Copyright:
© American Journal of Hypertension, Ltd 2016. All rights reserved.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - BACKGROUND One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. METHODS We conducted a prospective study of the association between baseline OH (1987–1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20 mm Hg or diastolic blood pressure (DBP) ≥10 mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables. RESULTS During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per −5 mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per −5 mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002). CONCLUSIONS In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls.
AB - BACKGROUND One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. METHODS We conducted a prospective study of the association between baseline OH (1987–1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20 mm Hg or diastolic blood pressure (DBP) ≥10 mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables. RESULTS During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per −5 mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per −5 mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002). CONCLUSIONS In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls.
KW - ARIC
KW - blood pressure
KW - epidemiology
KW - fall
KW - hypertension
KW - orthostatic hypotension
KW - prospective cohort
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U2 - 10.1093/ajh/hpw108
DO - 10.1093/ajh/hpw108
M3 - Article
C2 - 27638848
AN - SCOPUS:85020070234
SN - 0895-7061
VL - 30
SP - 188
EP - 195
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 2
ER -