title: Impaired systolic blood pressure recovery directly after standing predicts mortality in older falls clinic patients.
abstract: BACKGROUND
  Normally, standing up causes a blood pressure (BP) drop within 15 seconds, followed by recovery to baseline driven by BP control mechanisms. The prognostic value of this initial BP drop, but also of the recovery hereafter, is unknown. The aim of this study was to examine the prognostic value of these BP characteristics in response to standing.
  
  
  METHODS
  In a retrospective cohort study of 238 consecutive patients visiting our falls outpatient clinic, we examined the relation between all-cause mortality and BP decline and recovery directly after active standing up with Cox proportional hazards analyses.
  
  
  RESULTS
  Of 238 patients (mean age 78.4 ± 7.8 years), during a median follow-up of 21.0 months, 36 (15%) patients died. Neither absolute nor relative (%) initial BP drop after standing predicted mortality. In contrast, the magnitude of BP recovery 40-60 seconds after standing was associated with mortality, even after adjustment for age, comorbidity, and other baseline characteristics. When systolic BP had recovered to less than 80% of prestanding baseline after 60 seconds of standing, this was a powerful independent predictor of mortality (hazard ratio: 3.00; 95% confidence interval 1.17-7.68).
  
  
  CONCLUSIONS
  Failure to recover from BP decline in the first minute after active standing up is associated with excess mortality in falls clinic patients. A recovery of systolic BP to less than 80% of baseline after 60 seconds may be used as an easily available cardiovascular marker for increased mortality risk in older falls clinic patients.
authors.affiliation: Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, University mail code 925, PO Box 9100, 6500 HB Nijmegen, The Netherlands. J.Lagro@ger.umcn.nl.
authors.forename: Joep
authors.initials: J
authors.lastname: Lagro
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schoon
authors.forename: Inger
authors.initials: I
authors.lastname: Heerts
authors.forename: Aisha S S
authors.initials: AS
authors.lastname: Meel-van den Abeelen
authors.forename: Bianca
authors.initials: B
authors.lastname: Schalk
authors.forename: Wouter
authors.initials: W
authors.lastname: Wieling
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.forename: Jurgen A H R
authors.initials: JA
authors.lastname: Claassen
mesh_terms: D000058:Accidental Falls / Q000401:mortality*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002423:Cause of Death / Q000639:trends; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011187:Posture / Q000502:physiology*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Cardiovascular; Multimorbidities; Outcomes.; Physiology; Resilience