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 Nijmegen the Netherlands.
J Am Heart Assoc. 2020 Apr 7;9(7):e014688. doi: 10.1161/JAHA.119.014688. Epub 2020 Mar 30.
Background The relationship between orthostatic hypotension and clinical outcome in older adults is poorly understood. Blood pressure drop rate (ie, speed of blood pressure drop) may particularly reflect the imposed challenge to the baroreflex and the associated clinical outcome (ie, frailty and number of falls). This study aimed to compare orthostatic blood pressure drop rate and drop magnitude with regard to their association with frailty and number of falls. Methods and Results Blood pressure was measured continuously during a standardized active stand task in 168 patients (mean age 81.4±7.0; 55.4% female) who visited a geriatric outpatient clinic for cognitive or mobility problems. The association of orthostatic blood pressure drop rate, blood pressure drop magnitude, and baroreflex sensitivity (ie, increase in heart rate divided by systolic blood pressure drop magnitude) with frailty (Fried criteria and 4 frailty markers) and self-reported number of falls was assessed using linear regression models, adjusting for age and sex. Systolic blood pressure drop rate had the strongest association with frailty according to the 4 frailty markers (β 0.30; 95% CI, 0.11-0.49; =0.003) and number of falls (β 1.09; 95% CI, 0.19-1.20; =0.018); diastolic blood pressure drop magnitude was most strongly associated with frailty according to the Fried criteria (β 0.37; 95% CI, 0.15-0.60; <0.001). Baroreflex sensitivity was associated with neither frailty nor number of falls. Conclusions Orthostatic blood pressure drop rate was associated with frailty and falls and may reflect the challenge to the baroreflex rather than drop magnitude.
背景 体位性低血压与老年人临床结局之间的关系尚未明确。血压下降率（即血压下降速度）可能特别反映了对压力反射的挑战及其相关的临床结局（即虚弱和跌倒次数）。本研究旨在比较体位性血压下降率和下降幅度与虚弱和跌倒次数的关系。
方法和结果 在 168 名（平均年龄 81.4±7.0 岁，55.4%为女性）因认知或移动问题就诊老年门诊的患者中，使用连续血压监测仪在标准化主动站立任务期间测量血压。使用线性回归模型评估体位性血压下降率、血压下降幅度和压力反射敏感性（即心率增加除以收缩压下降幅度）与虚弱（Fried 标准和 4 项虚弱标志物）和自我报告的跌倒次数之间的关系，调整年龄和性别。收缩压下降率与 4 项虚弱标志物（β 0.30；95%CI，0.11-0.49；=0.003）和跌倒次数（β 1.09；95%CI，0.19-1.20；=0.018）具有最强的相关性；舒张压下降幅度与 Fried 标准（β 0.37；95%CI，0.15-0.60；<0.001）最相关。压力反射敏感性与虚弱或跌倒次数均无相关性。
结论 体位性血压下降率与虚弱和跌倒有关，可能反映了对压力反射的挑战，而不是下降幅度。
