Orthostatic Hypotension in Middle-Age and Risk of Falls

Stephen P. Juraschek, Natalie Daya, Lawrence J. Appel, Edgar R. Miller, Beverly Gwen Windham, Lisa Pompeii, Michael E. Griswold, Anna Kucharska-Newton, Elizabeth Selvin

Research output: Contribution to journalArticlepeer-review


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) ≥20mm Hg or diastolic blood pressure (DBP) ≥10mm 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 -5mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per -5mm 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.

Original languageEnglish (US)
Pages (from-to)188-195
Number of pages8
JournalAmerican Journal of Hypertension
Issue number2
StatePublished - Feb 1 2017


  • ARIC
  • blood pressure
  • epidemiology
  • fall
  • hypertension
  • orthostatic hypotension
  • prospective cohort.

ASJC Scopus subject areas

  • Internal Medicine

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