Orthostatic blood pressure fluctuations and risk of falls in community-dwelling older adults: the role of recovery time

Background Available literature related to the association between orthostatic blood pressure (BP) variations and falls is controversial. We analyzed how orthostatic hypo- (OH) and hypertension (OHTN) relate to falls considering recovery time (RT) in community-dwelling older adults. Methods This analysis uses data from the ActiFE cohort. BP was measured lying, immediately, 1, 2 and 3 min after standing. Systolic OH (sOH) and systolic OHTN (sOHTN) indicate a systolic BP (SBP) drop or increment ≥20 mm Hg, respectively. OH and OHTN further consider a diastolic BP (DBP) drop or increment ≥10 mm Hg. RT was categorized as Early Recovery ( < 1 min), Delayed Recovery (1-3 min), or No Recovery. Falls over 12 months were collected prospectively. Logistic regression examined associations with falls, adjusting for age, sex, diabetes, hemoglobin, instrumental activities of daily living, hand strength, fall risk-increasing drugs, past falls, Falls Efficacy Scale-International and anxiety. Results Among 509 subjects (mean age 79 years, 44% female, 168 falls), prevalences were: 16.5% sOH, 26.9% OH, 9.0% sOHTN and 15.5% OHTN. Overall, OH was not associated with falls. However, falls risk increased with Delayed (OR 3.11 [95% CI 1.21-8.01]) and NoRecovery (OR 4.04 [95% CI 1.07-15.26]). sOH showed an adjusted OR of 2.00 [95% CI 1.15-3.47] for at least one fall. Regarding RT the risk of falls was increased in Delayed (OR 4.73 [95% CI 1.71-13.10]) and No Recovery (OR 5.06 [95% CI 1.42-22.27]). OHTN was not associated with falls. Conclusions Overall, only sOH was associated with falls. When RT was considered, those with Delayed and No Recovery showed higher risk of falls regardless of the OH definition used.