Key result
The pooled prevalence of continuously measured initial orthostatic hypotension in adults aged 65 years or older was 29.0% (95% CI: 22.1-36.9%), with the highest rates in geriatric outpatients.
Why the study?
Initial orthostatic hypotension is associated with higher risks of falls, frailty, and syncope in older adults, but a clear prevalence estimate was needed.
What is the prevalence of initial orthostatic hypotension in adults aged 65 years or older?
Meta-Analysis (n=5,465)
What is the prevalence of initial orthostatic hypotension in adults aged 65 years or older?
Initial orthostatic hypotension is highly prevalent in older adults, particularly in geriatric outpatients, and requires continuous blood pressure measurement for proper assessment.
High prevalence warrants screening older outpatients with continuous BP; extends estimates across settings and measurement methods.
BACKGROUND: Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults. OBJECTIVE: To provide a prevalence estimate of initial OH in adults aged 65 years or older. METHODS: Literature search of MEDLINE (from 1946), Embase (from 1947) and Cochrane Central Register of Controlled Trials was performed until 6 December 2019, using the terms 'initial orthostatic hypotension', 'postural hypotension' and 'older adults'. Articles were included if published in English and participants were 65 years or older. Random effects models were used for pooled analysis. RESULTS: Of 5,136 articles screened, 13 articles (10 cross-sectional; 3 longitudinal) reporting data of 5,465 individuals (54.5% female) from the general (n = 4,157), geriatric outpatient (n = 1,136), institutionalised (n = 55) and mixed (n = 117) population were included. Blood pressure was measured continuously and intermittently in 11 and 2 studies, respectively. Pooled prevalence of continuously measured initial OH was 29.0% (95% CI: 22.1-36.9%, I2 = 94.6%); 27.8% in the general population (95% CI: 17.9-40.5%, I2 = 96.1%), 35.2% in geriatric outpatients (95% CI: 24.2-48.1%, I2 = 95.3%), 10.0% in institutionalised individuals (95% CI: 2.4-33.1%, I2 = 0%) and 21.4% in the mixed population (95% CI: 7.0-49.6, I2 = 0%). Pooled prevalence of intermittently measured initial OH was 5.6% (95% CI: 1.5-18.9%, I2 = 81.1%); 1.0% in the general population (95% CI: 0.0-23.9%, I2 = 0%) and 7.7% in geriatric outpatients (95% CI: 1.8-27.0%, I2 = 86.7%). CONCLUSION: The prevalence of initial OH is high in older adults, especially in geriatric outpatients. Proper assessment of initial OH requires continuous blood pressure measurements.
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Tran et al. (2021) conducted a meta-analysis in Initial orthostatic hypotension (n=5,465). Older age (≥65 years) was evaluated on Pooled prevalence of continuously measured initial orthostatic hypotension (95% CI 22.1-36.9). The pooled prevalence of continuously measured initial orthostatic hypotension in adults aged 65 years or older was 29.0% (95% CI: 22.1-36.9%), with the highest rates in geriatric outpatients.
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