title: Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.
abstract: OBJECTIVE
  To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH).
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Geriatric research clinic.
  
  
  METHODS
  Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy.
  
  
  METHODS
  Active lying-to-standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline - nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5-second averages method and entered in K-means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria).
  
  
  RESULTS
  The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH- (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH- (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005).
  
  
  CONCLUSIONS
  It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people.
authors: Technology Research for Independent Living Centre, Trinity College, Dublin, Ireland. romeror@tcd.ie
authors: Roman
authors: R
authors: Romero-Ortuno
authors: Lisa
authors: L
authors: Cogan
authors: Tim
authors: T
authors: Foran
authors: Rose Anne
authors: RA
authors: Kenny
authors: Chie Wei
authors: CW
authors: Fan
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D054971:Orthostatic Intolerance / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D012307:Risk Factors