The prevalence and pathological correlates of orthostatic hypotension and its subtypes when measured using beat-to-beat technology in a sample of older adults living in the community.
BACKGROUND
beat-to-beat technology is increasingly used for investigating orthostatic intolerance (OI) but the prevalence of orthostatic hypotension (OH) diagnosed with this technology is unclear.


OBJECTIVE
(i) to use beat-to-beat technology to define the prevalence of OH, (ii) to investigate the pathological correlates of OH, (iii) to report the diversity of postural BP responses.


METHODS
cross-sectional study of adults ≥ 65 years. BP responses to a 3-min head-up tilt were analysed.


RESULTS
of 326 participants, 203(62.3%) were females. The median (IQR) age was 73 (70-78). One hundred and ninety-one (58.6%) met standard (20 mmHg systolic/10 mmHg diastolic) criteria for OH. The prevalence was higher in females (60.1% F versus 56.1% M); 47% were arteriolar subtype, 33% were venular, 9% were mixed and 11.0% could not be classified. Morphological analysis identified 102 subjects with 'small drop, overshoot', 131 with 'medium drop, slow recovery' and 31 with 'large drop, nonrecovery'. Those with OH had a lower BMI (P = 0.02), a higher resting heart rate (P = 0.005), were more likely to take a psychotropic (P = 0.02), have vertigo (P = 0.004) and report OI (P = 0.02). The 95th centile for the duration of systolic BP (SYSBP) decay >20 mmHg was 175 s and the slope of systolic BP decay was 4.75 mmHg/s. The 5th centile for percentage recovery of SYSBP was 81.4%.


CONCLUSIONS
(i) beat-to-beat methods identify a higher prevalence of OH than sphygmomanometry, (ii) the pathological correlates of OH diagnosed in this manner are similar to those described for sphygmomanometry, (iii) there is a diverse pattern of orthostatic BP decay that could be used in future research to predict adverse outcomes in OH.
Division of Ageing and Therapeutics, Department of Medicine, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
John
J
Cooke
Sheila
S
Carew
Colin
C
Quinn
Margaret
M
O'Connor
John
J
Curtin
Caroline
C
O'Connor
Jean
J
Saunders
Eileen
E
Humphreys
Stiofan
S
Deburca
David
D
Clinch
Declan
D
Lyons
D000367:Age Factors; D000368:Aged; D000375:Aging; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D007024:Hypotension, Orthostatic / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D057187:Independent Living; D007494:Ireland / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D056888:Patient Positioning; D017156:Photoplethysmography; D011237:Predictive Value of Tests; D015995:Prevalence; D020127:Recovery of Function; D019722:Sphygmomanometers; D018667:Tilt-Table Test; D013997:Time Factors
Finometer; older people; orthostatic hypotension; prevalence