title: Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty.
abstract: Systolic hypertension and OH, as with many other deficits, accumulate with age. This deficit accumulation results in frailty: enhanced vulnerability to adverse outcomes. This study evaluated OH in relation to age, frailty, systolic hypertension, and mortality. In the population-based Canadian Study of Health and Aging second clinical examination, complete data were available on 1347 people, mean age=83.3 (SD=6.4)years. A frailty index (FI) was calculated from a 52-item Comprehensive Geriatric Assessment (CGA), yielding an FI-CGA from 0 (no deficits) to 1.0 (52 deficits). The mean change in blood pressure from lying to standing was 7.3±15.6 mmHg (range +94 to -60). In total, 239 people (17.7%) had OH (change >20 mmHg systolic or >10 mmHg diastolic). Mean systolic blood pressure was higher (155.8±23.3 mmHg) in people with OH than in those without (141.4±23 mmHg), as was the FI-CGA (0.18 vs. 0.16). OH increased with frailty and systolic hypertension, but not age. Unadjusted, OH was associated with an increased risk of death (relative risk=1.21, 95% confidence interval 1.19-1.23). Adjusted for frailty, this result was not significant. OH may be a marker of the system dysregulation seen in frailty, but as a state variable is a less powerful marker of vulnerability than is the FI-CGA.
authors.affiliation: Division of Geriatric Medicine, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada.
authors.forename: Michael R H
authors.initials: MR
authors.lastname: Rockwood
authors.forename: Susan E
authors.initials: SE
authors.lastname: Howlett
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001794:Blood Pressure; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000401:mortality; D007024:Hypotension, Orthostatic / Q000401:mortality*; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index; D012737:Sex Factors