Key result
Sustained orthostatic SBP drops over 30 seconds are linked to ~45% mortality at 5 years.
Why the study?
Does a sustained orthostatic reduction in systolic blood pressure predict death in patients attending a falls and syncope clinic?
Observational (n=103)
No
Does a sustained orthostatic reduction in systolic blood pressure predict death in patients attending a falls and syncope clinic?
p-value: p=0.009
A sustained orthostatic reduction in systolic blood pressure lasting ≥30 seconds is predictive of increased 5-year mortality, whereas transient drops are not clinically significant.
May flag higher-risk patients for monitoring in syncope clinics; leaves open whether intervention alters survival.
BACKGROUND: Orthostatic hypotension (OH) affects 6% of community-dwelling older people. This increases to 60% when non-invasive, continuous blood pressure (BP) monitoring is used, due to identification of transient drops in BP which recover rapidly. AIM: To determine the clinical relevance of these transient orthostatic BP drops. DESIGN: Five-year clinical observational study. METHODS: One hundred three consecutive new patients attending a Falls and Syncope Clinic in the UK from 1 February 2009 underwent continuous BP monitoring during an active stand. BP profiles were analysed to quantify all reductions in BP, measuring the duration of any drop below diagnostic criteria. Five-year follow-up data were extracted from hospital clinical records to assess clinical outcomes. RESULTS: Systolic BP (sBP) dropped ≥20 mmHg in 76 (74%) individuals, with 65 (63%) having ≥10 mmHg drop in diastolic BP. However, only 22 (21%) cases were diagnosed clinically with OH. A sustained reduction in BP (≥30 s) had a sensitivity of 0.91 and specificity of 0.88 for a clinical diagnosis of OH, being more accurate than absolute BP reduction alone. A sustained reduction in sBP was associated with greater use of vasopressors (36%,P0.001) and an independent, significantly greater risk of death (45% at 5 years,P0.009). CONCLUSION: An orthostatic reduction in sBP lasting ≥30 s improves accuracy of diagnosis. Moreover, given the significant adverse outcomes with a sustained reduction, clinicians should consider this when diagnosing and treating patients, as transient OH does not appear to be clinically significant.
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Frith et al. (2015) conducted an observational in Orthostatic hypotension (n=103). Sustained reduction in systolic blood pressure (≥30 s) vs. Transient reduction or no reduction was evaluated on Death (p=0.009). A sustained reduction in systolic blood pressure lasting ≥30 seconds was associated with an independent, significantly greater risk of death (45% at 5 years, P=0.009).
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