Comparison of supine and seated orthostatic hypotension assessments and their association with falls and orthostatic symptoms
Key result
Supine assessment detected orthostatic hypotension more frequently than seated assessment (15.0% vs 2.1%, P<0.001); supine systolic OH was associated with higher fall risk (HR 1.77; 95% CI 1.02-3.05).
Why the study?
Orthostatic hypotension based on seated-to-standing blood pressure changes is often used interchangeably with supine-to-standing blood pressure.
Does supine-to-standing orthostatic hypotension assessment better predict falls and orthostatic symptoms compared to seated-to-standing assessment in older adults at high risk of falls?
Population
534 adults aged ≥70 years at high risk of falls
Comparison
Seated-to-standing vs supine-to-standing blood pressure protocols
Design
Ancillary study within a randomized trial
Follow-up
24-month visits
Authors
Discussion
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Implication
Supine OH assessment identifies more symptomatic cases potentially linked to falls than seated; challenges interchangeable use and supports supine protocols in older adults.
Key Points
- The aim is to compare supine and seated assessments of orthostatic hypotension and their relation to falls and symptoms in older adults.
- Randomized trial involving 534 adults aged ≥70 years at high risk of falls.
- Orthostatic hypotension measured using seated-to-standing and supine-to-standing protocols.
- Participants reported symptoms and falls were tracked using calendars and interviews.
- Seated orthostatic hypotension detected in 2.1% vs. supine in 15.0% (P < 0.001).
- Supine systolic orthostatic hypotension linked to higher fall risk (HR: 1.77 [1.02, 3.05]).
- Supine OH associated with symptoms like fainting and dizziness (P-values < 0.03), not seen with seated OH (P-values ≥ 0.40).
Study Design
Type
RCT (n=534)
Structured PICO
Does supine-to-standing orthostatic hypotension assessment better predict falls and orthostatic symptoms compared to seated-to-standing assessment in older adults at high risk of falls?
P
Population
534 adults aged ≥70 years at high risk of falls (62% with history of hypertension), undergoing paired supine and seated orthostatic hypotension assessments over 24 months.
I
Intervention
Supine-to-standing orthostatic hypotension assessment
C
Comparator
Seated-to-standing orthostatic hypotension assessment
O
Outcome
Falls (ascertained via daily fall calendar, ad hoc reporting, and scheduled interviews) and self-reported orthostatic symptomshard clinical
Main Result
Absolute Event Rate: 15% vs 2.1%
p-value: p=<0.001
Supine-to-standing blood pressure assessment is more sensitive for detecting orthostatic hypotension and better predicts falls and symptoms than seated-to-standing assessment in older adults.
Cite This Study
Juraschek et al. (2022) conducted an RCT in High risk of falls (n=534). Supine-to-standing orthostatic hypotension assessment vs. Seated-to-standing orthostatic hypotension assessment was evaluated on Detection of orthostatic hypotension (p=<0.001). Supine assessment detected orthostatic hypotension more frequently than seated assessment (15.0% vs 2.1%, P<0.001); supine systolic OH was associated with higher fall risk (HR 1.77; 95% CI 1.02-3.05).