Objective: Hypertension and postural hypotension (PH) often co-exist with advancing age. Current guidelines recommend individuals with PH be treated to a standing blood pressure (BP) target. However, the association between standing BP and adverse outcomes is unknown. This study aimed to 1) estimate the association between standing BP and major adverse cardiovascular events (MACE) and injurious falls and 2) determine the modifying effect of PH, frailty and other co-morbidity on these associations. Design and method: A systematic review was undertaken to identify studies in adults aged 70 years and above with sitting or lying and standing BP, with at least 2 years follow-up, reporting cardiovascular, falls, mortality or cognitive outcomes. Two-stage individual participant data (IPD) meta-analysis and time-to-event analysis were performed. Estimates of associations were adjusted for confounding variables including age, sex, and history of cardiovascular diseases. Results: Our systematic review identified 13,448 papers, of which 9,234 unique titles and abstracts underwent double screening. In total, 345 full-text articles were reviewed for eligibility; 16 papers (representing 14 unique study databases) met inclusion criteria and were contacted for IPD. Of these studies, IPD were sought from 12 study datasets. We have currently acquired data from 3 studies (2,433 participants) and present pilot analysis of the InCHIANTI Study, the OPTiMISE Randomised Clinical Trial, and the PARTAGE study. Overall, there was no evidence of an association between standing BP and MACE (hazard ratio HR: 1.057, 95% confidence interval CI 0.972 to 1.148). Similarly, there was no evidence of an association between sitting/lying BP and MACE (HR=1.027, 95%CI 0.850 to 1.240). There was insufficient data to conduct IPD meta-analysis for falls outcome. Secondary analysis also suggested no evidence of an association between standing BP or sitting/lying BP and other adverse events, such as all-cause mortality, hospitalisations, and other cardiovascular disease events. Conclusions: This pilot IPD meta-analysis of the three studies acquired to date, found no evidence of an association between standing BP or sitting/lying BP and adverse outcomes, although sample size was small. Acquisition of further data from other eligible studies is ongoing and may offer further insight.
Wang et al. (Fri,) studied this question.