The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland.
Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.
Age Ageing. 2021 May 5;50(3):854-860. doi: 10.1093/ageing/afaa174.
Orthostatic hypotension (OH) can be assessed with non-invasive continuous beat-to-beat haemodynamic monitoring during active stand (AS) testing; this yields large volumes of data outside the scope of the traditional OH definition. We explored clinical associations of different AS patterns in participants from Wave 1 of the Irish Longitudinal Study on Ageing.
AS patterns were generated based on three sequential binary systolic blood pressure features: drop ≥40 mmHg within 10 sec post-stand ("immediate deficit"), failure to return to within 20 mmHg of supine level at 40 sec after standing ("stabilisation deficit") and drop ≥20 mmHg between >40 and 120 sec post-stand ("late deficit"). Eight AS groups resulted from combining the presence/absence of these three features. The groups were cross-sectionally characterised, and their ability to independently predict orthostatic intolerance (OI) during AS, and falls or syncope in the past year, was evaluated using multivariate logistic regression models.
A total of 4,899 participants were included (mean age 61), of which 3,312 (68%) had no deficits. Older age was associated with stabilisation deficit and late deficits were seen in groups with higher proportions of beta blockers and psychotropic medications. Regression models identified independent associations between OI and three immediate-deficit groups; associations seemed stronger as more deficits were present. There was a significant association between falls history and the three-deficit group (odds ratio 1.54, 95% confidence interval: 1.15-2.07, P = 0.004).
More deficits seemed associated with the higher risk of OI and falls history. Observations are not causal but the recognition of these patterns may help clinicians focus on careful prescribing.
体位性低血压（OH）可以通过在主动站立（AS）测试期间对非侵入性连续搏动血压进行监测来评估；这会产生大量超出传统 OH 定义范围的数据。我们在爱尔兰老龄化纵向研究的第 1 波参与者中探讨了不同 AS 模式的临床关联。
根据三个连续的收缩压特征生成 AS 模式：站立后 10 秒内下降≥40mmHg（“即时缺陷”）、站立后 40 秒内未恢复至仰卧位水平 20mmHg 以内（“稳定缺陷”）和站立后 40 至 120 秒之间下降≥20mmHg（“晚期缺陷”）。这三个特征的存在/不存在组合产生了八个 AS 组。使用多变量逻辑回归模型对这些组进行了横断面描述，并评估了它们独立预测 AS 期间直立不耐受（OI）和过去一年中跌倒或晕厥的能力。
共有 4899 名参与者被纳入（平均年龄 61 岁），其中 3312 名（68%）没有缺陷。年龄较大与稳定缺陷有关，并且在β受体阻滞剂和精神药物比例较高的组中可见晚期缺陷。回归模型确定了 OI 与三个即时缺陷组之间的独立关联；随着缺陷的增加，关联似乎更强。过去有跌倒史与三缺陷组之间存在显著关联（优势比 1.54，95%置信区间：1.15-2.07，P=0.004）。
更多的缺陷似乎与更高的 OI 和跌倒史风险相关。观察结果不是因果关系，但认识到这些模式可能有助于临床医生专注于谨慎处方。
