de Matos Dihogo Gama, de Santana Jefferson Lima, Aidar Felipe J, Cornish Stephen M, Giesbrecht Gordon G, Mendelson Asher A, Duhamel Todd A, Villar Rodrigo
Cardiorespiratory & Physiology of Exercise Research Laboratory, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada.
Graduate Program in Physical Education and Kinesiology and Physiological Sciences, Federal University of Sergipe, Sao Cristovao, Brazil.
Arch Gerontol Geriatr. 2025 Sep;136:105894. doi: 10.1016/j.archger.2025.105894. Epub 2025 May 16.
Orthostatic hypotension (OH) is a relevant cardiovascular disorder associated with frailty and delayed cardiovascular regulatory responses, contributing to cardiovascular dysregulation. This dysregulation affects blood pressure (BP) control, increasing the risk of falls and mortality. This systematic review aimed to determine whether older adults living with frailty have impaired cardiovascular regulatory responses during active standing orthostatic stress.
MEDLINE (from 1946), PUBMED (from 1966), EMBASE (from 1974), CINAHL (from 1963), and SCOPUS (from 2004) were systematically searched for studies on cardiovascular regulation during active standing orthostatic stress in older adults living with frailty. The selection of studies involved the following criteria: ≥ 60 years, OH classification, continuous monitoring of beat-by-beat BP, active standing, and frailty status. The nine-point Newcastle-Ottawa Scale was used to assess the study quality.
Of 7441 articles identified, 5 articles were included, but 3 independent data sets were extracted due to two studies reporting the same participants' cohort, resulting in an analysis of 726 participants (79±5 years, 41.7 % males). Frailty was associated with a greater drop in BP (-61 mmHg), blunted HR (Frail: 8 bpm; non-frail: 16 bpm), and longer recovery after active standing, occurring between 30-60 s instead of 0-30 s (healthy systems). OH prevalence ranged from 3 to 98 %, being higher in frail people.
Older adults living with frailty experience a greater drop in BP, a blunted HR response, and prolonged recovery time following active-standing orthostatic stress. This cardiovascular dysregulation contributes to the highest prevalence of OH among frail individuals.
直立性低血压（OH）是一种与身体虚弱及心血管调节反应延迟相关的心血管疾病，会导致心血管调节功能失调。这种调节功能失调会影响血压（BP）控制，增加跌倒和死亡风险。本系统评价旨在确定身体虚弱的老年人在主动站立直立应激期间是否存在心血管调节反应受损的情况。
系统检索MEDLINE（始于1946年）、PUBMED（始于1966年）、EMBASE（始于1974年）、CINAHL（始于1963年）和SCOPUS（始于2004年），以查找有关身体虚弱的老年人在主动站立直立应激期间心血管调节的研究。研究选择涉及以下标准：年龄≥60岁、OH分类、逐搏血压连续监测、主动站立和虚弱状态。采用九点纽卡斯尔-渥太华量表评估研究质量。
在检索到的7441篇文章中，纳入了5篇文章，但由于两项研究报告的是同一参与者队列，因此提取了3个独立数据集，最终分析了726名参与者（79±5岁，41.7%为男性）。虚弱与更大的血压下降（-61 mmHg）、心率变钝（虚弱者：8次/分钟；非虚弱者：16次/分钟）以及主动站立后更长的恢复时间有关，恢复时间在30 - 60秒之间，而不是健康系统的0 - 30秒。OH患病率在3%至98%之间，在虚弱人群中更高。
身体虚弱的老年人在主动站立直立应激后血压下降幅度更大、心率反应变钝且恢复时间延长。这种心血管调节功能失调导致虚弱个体中OH的患病率最高。
