Impaired Orthostatic Blood Pressure Recovery is associated with Unexplained and Injurious Falls

Background/Objectives: Cardiovascular disorders are recognised as important modifiable risk factors for falls. However the association between falls and orthostatic hypotension (OH) remains ambivalent, particularly because of poor measurement methods of previous studies. Our goal was to determine for the first time to what extent OH (and variants) are risk factors for incident falls, unexplained falls (UF), injurious falls (IF) and syncope using dynamic blood pressure (BP) measurements in a population study. Design: Nationally Representative Longitudinal Cohort Study - The Irish Longitudinal Study on Ageing (TILDA) – wave 1 (2009-2011) with 2 year follow-up at wave 2 (2012-2013). Setting: Community dwelling adults. Participants: 4127 participants were randomly sampled from the population of older adults aged ≥50 years resident in Ireland. Measurements: Continuous BP recordings measured during active stands were analysed. OH and variants (initial OH and impaired orthostatic BP stabilisation OH(40)) were defined using dynamic BP measurements. Associations with the number of falls, UF, IF and syncope reported two years later were assessed using negative binomial and modified Poisson regression. Results: Participants had a mean age 61.5(8.2) years (54.2% female). OH(40) was associated with increased relative risk of UF (RR:1.52 95%CI:1.03-2.26). OH was associated with all-cause falls (IRR:1.40 95%CI:1.01-1.96), UF(RR:1.81 95%CI:1.06-3.09), and IF(RR:1.58 95%CI:1.12-2.24). IOH was not associated with any outcome. Conclusion: With the exception of initial orthostatic hypotension, beat-to-beat measures of impaired orthostatic BP recovery (delayed or incomplete stabilisation) are independent risk factors for future falls, unexplained falls, and injurious falls