Hartog Laura Caroline, Schrijnders Dennis, Landman G W D, Groenier Klaas, Kleefstra Nanne, Bilo Henk J G, van Hateren Kornelis Johannes Jongers
Diabetes Centre, Isala, PO Box 10400, Zwolle 8000 GK, The Netherlands.
Langerhans Medical Research Group, The Netherlands.
Age Ageing. 2017 Jul 1;46(4):568-575. doi: 10.1093/ageing/afx024.
orthostatic hypotension (OH) is one out of many risk factors believed to contribute to an increased fall risk in elderly subjects but it is unclear whether an independent association between OH and falling exists.
to perform an individual patient data (IPD) meta-analysis of prospective observational studies investigating the relationship between OH and falling.
MEDLINE, EMBASE, the Cochrane Library and the abstracts of annual meetings of selected hypertension societies were searched. Both one-stage (analysing all IPD from all studies simultaneously) and two-stage (analysing IPD per study, and then pooling the results) methods were used, and both logistic and cox regression analyses were performed. The study protocol was published on PROSPERO (2015:CRD42015019178).
from 34 selected abstracts, 6 studies were included. IPD were provided in 1,022 patients from 3 cohorts and were included in the IPD meta-analysis. The one-stage meta-analysis showed a significant relationship between OH and time to first fall incident (hazard ratio (HR) 1.52 (95% Confidence Interval (CI) 1.23-1.88)). No significant relationship between OH and falling was found in the one-stage logistic regression analysis and the two-stage logistic and cox regression analyses.
this IPD meta-analysis of prospective observational studies showed a clear and significant relationship between OH and time to first fall incident. Although the ORs of falling was not significantly different for patients with and without OH, a the cox regression analyses reporting HRs and including time to incident provided more clinically relevant information in present meta-analysis.
体位性低血压（OH）是众多被认为会增加老年受试者跌倒风险的危险因素之一，但OH与跌倒之间是否存在独立关联尚不清楚。
对前瞻性观察性研究进行个体患者数据（IPD）荟萃分析，以调查OH与跌倒之间的关系。
检索了MEDLINE、EMBASE、Cochrane图书馆以及选定高血压学会年会的摘要。采用了单阶段（同时分析所有研究的所有IPD）和两阶段（每项研究分别分析IPD，然后汇总结果）方法，并进行了逻辑回归和Cox回归分析。研究方案已发表在PROSPERO上（2015：CRD42015019178）。
从34篇选定的摘要中，纳入了6项研究。来自3个队列的1022名患者提供了IPD，并纳入了IPD荟萃分析。单阶段荟萃分析显示OH与首次跌倒事件发生时间之间存在显著关系（风险比（HR）1.52（95%置信区间（CI）1.23 - 1.88））。在单阶段逻辑回归分析以及两阶段逻辑回归和Cox回归分析中，未发现OH与跌倒之间存在显著关系。
这项对前瞻性观察性研究的IPD荟萃分析显示OH与首次跌倒事件发生时间之间存在明确且显著的关系。尽管有OH和无OH的患者跌倒的比值比没有显著差异，但在当前的荟萃分析中，报告HR并纳入事件发生时间的Cox回归分析提供了更多临床相关信息。
