Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Faculty of Science, Nijmegen, the Netherlands.
Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia.
J Am Med Dir Assoc. 2019 May;20(5):589-597.e5. doi: 10.1016/j.jamda.2018.11.003. Epub 2018 Dec 21.
Orthostatic hypotension is a potential risk factor for falls in older adults, but existing evidence on this relationship is inconclusive. This study addresses the association between orthostatic hypotension and falls.
Systematic review and meta-analysis of the cross-sectional and longitudinal studies assessing the association between orthostatic hypotension and falls, as preregistered in the PROSPERO database (CRD42017060134).
A literature search was performed on February 20, 2017, in MEDLINE (from 1946), PubMed (from 1966), and EMBASE (from 1947) using the terms orthostatic hypotension, postural hypotension, and falls. References of included studies were screened for other eligible studies. Study selection was performed independently by 2 reviewers using the following inclusion criteria: published in English; mean/median age of the population ≥65 years; blood pressure measurement before and after postural change; and assessment of the association of orthostatic hypotension with falls. The following studies were excluded: conference abstracts, case reports, reviews, and editorials. Data extraction was performed independently by 2 reviewers.
Unadjusted odds ratios of the association between orthostatic hypotension and falls were used for pooling using a random effects model. Studies were rated as high, moderate, or low quality using the Newcastle-Ottawa Scale.
Out of 5646 studies, 63 studies (51,800 individuals) were included in the systematic review and 50 studies (49,164 individuals) in the meta-analysis. Out of 63 studies, 39 were cross-sectional and 24 were longitudinal. Orthostatic hypotension was positively associated with falls (odds ratio 1.73, 95% confidence interval 1.50-1.99). The result was independent of study population, study design, study quality, orthostatic hypotension definition, and blood pressure measurement method.
Orthostatic hypotension is significantly positively associated with falls in older adults, underpinning the clinical relevance to test for an orthostatic blood pressure drop and highlighting the need to investigate orthostatic hypotension treatment to potentially reduce falls.
直立性低血压是老年人跌倒的潜在危险因素，但现有证据对此相关性的结论并不明确。本研究旨在探讨直立性低血压与跌倒之间的关系。
对评估直立性低血压与跌倒之间相关性的横断面和纵向研究进行系统评价和荟萃分析，该研究已在 PROSPERO 数据库（CRD42017060134）中预先注册。
于 2017 年 2 月 20 日在 MEDLINE（自 1946 年起）、PubMed（自 1966 年起）和 EMBASE（自 1947 年起）中使用“orthostatic hypotension（直立性低血压）”、“postural hypotension（体位性低血压）”和“falls（跌倒）”等术语进行文献检索。对纳入研究的参考文献进行筛选，以查找其他符合条件的研究。研究选择由 2 名独立审查员进行，纳入标准如下：发表于英文期刊；研究人群的平均/中位年龄≥65 岁；有体位改变前后的血压测量值；评估直立性低血压与跌倒的相关性。排除标准为：会议摘要、病例报告、综述和社论。由 2 名独立审查员进行数据提取。
使用随机效应模型，对直立性低血压与跌倒之间关联的未经调整比值比进行汇总。使用纽卡斯尔-渥太华量表对研究进行高、中、低质量评级。
在 5646 项研究中，有 63 项研究（51800 名参与者）被纳入系统评价，50 项研究（49164 名参与者）被纳入荟萃分析。在 63 项研究中，39 项为横断面研究，24 项为纵向研究。直立性低血压与跌倒呈正相关（比值比 1.73，95%置信区间 1.50-1.99）。该结果独立于研究人群、研究设计、研究质量、直立性低血压定义和血压测量方法。
直立性低血压与老年人跌倒显著正相关，这突显了测试体位性血压下降的临床相关性，并强调了需要研究直立性低血压的治疗方法，以潜在减少跌倒。
