Key result
Frailty is linked to a ~50% blunted HR response and greater BP drop following active standing.
Why the study?
Orthostatic hypotension is associated with frailty and cardiovascular dysregulation, but whether older adults living with frailty have impaired cardiovascular regulatory responses during active standing orthostatic stress was uncertain.
Does frailty impair cardiovascular regulatory responses during active standing orthostatic stress in older adults?
Systematic Review (n=726)
Does frailty impair cardiovascular regulatory responses during active standing orthostatic stress in older adults?
Older adults with frailty exhibit significant cardiovascular dysregulation during active standing, characterized by greater blood pressure drops and blunted heart rate responses, contributing to higher orthostatic hypotension prevalence.
Frail adults may face heightened OH risk on standing; supports frailty as orthostatic modifier but needs prospective trials before practice change.
BACKGROUND: Orthostatic hypotension (OH) is a relevant cardiovascular disorder associated with frailty and delayed cardiovascular regulatory responses, contributing to cardiovascular dysregulation. This dysregulation affects blood pressure (BP) control, increasing the risk of falls and mortality. This systematic review aimed to determine whether older adults living with frailty have impaired cardiovascular regulatory responses during active standing orthostatic stress. METHODS: MEDLINE (from 1946), PUBMED (from 1966), EMBASE (from 1974), CINAHL (from 1963), and SCOPUS (from 2004) were systematically searched for studies on cardiovascular regulation during active standing orthostatic stress in older adults living with frailty. The selection of studies involved the following criteria: ≥ 60 years, OH classification, continuous monitoring of beat-by-beat BP, active standing, and frailty status. The nine-point Newcastle-Ottawa Scale was used to assess the study quality. RESULTS: Of 7441 articles identified, 5 articles were included, but 3 independent data sets were extracted due to two studies reporting the same participants' cohort, resulting in an analysis of 726 participants (79±5 years, 41.7 % males). Frailty was associated with a greater drop in BP (-61 mmHg), blunted HR (Frail: 8 bpm; non-frail: 16 bpm), and longer recovery after active standing, occurring between 30-60 s instead of 0-30 s (healthy systems). OH prevalence ranged from 3 to 98 %, being higher in frail people. CONCLUSIONS: Older adults living with frailty experience a greater drop in BP, a blunted HR response, and prolonged recovery time following active-standing orthostatic stress. This cardiovascular dysregulation contributes to the highest prevalence of OH among frail individuals.
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Matos et al. (2025) conducted a systematic review in Orthostatic hypotension and frailty (n=726). Frailty vs. Non-frail was evaluated on Cardiovascular regulatory responses during active standing orthostatic stress. Frailty in older adults was associated with a greater blood pressure drop (-61 mmHg), blunted heart rate response (8 vs 16 bpm), and prolonged recovery time following active standing.
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