title: Postural blood pressure electrocardiographic changes are associated with falls in older people.
abstract: OBJECTIVE
  To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope.
  
  
  METHODS
  In this cross-sectional study were included participants from The Malaysian Falls Assessment and Intervention Trial: fallers, aged 65 years or older with two or more falls or one injurious fall in 12 months, from a teaching hospital; and non-fallers, aged 65 years and older found through word-of-mouth and advertising. Noninvasive beat-to-beat blood pressure was measured at 10 min supine rest and 3 min standing. The maximal drop in systolic and diastolic pressure was calculated from a 12-lead ECG interpreted by a cardiologist. Basic demographics, medical history, and symptoms of dizziness, presyncope, and syncope were recorded for all patients.
  
  
  RESULTS
  We recruited 155 fallers and 112 non-fallers. Fallers had a significantly longer PR interval (179 ± 32 vs. 168 ± 27 ms, p = 0.013) and a longer corrected QT interval (449 ± 41 vs. 443 ± 39 msec, p = 0.008), and larger change in SBP (28 ± 14 vs. 19 ± 9 mmHg, p < 0.001) with posture change. SBP drop of ≥30mmHg associated with recurrent and injurious falls [odds ratio [95 % confidence interval] = 7.61 (3.18-18.21)]. The changes remained significant after adjustment for symptoms of dizziness, presyncope and syncope.
  
  
  CONCLUSIONS
  Older individuals with recurrent and injurious falls have significantly longer PR and QT intervals and larger SBP reduction with posture change as compared to non-fallers, and these are not explained by the presence of dizziness, presyncope, or syncope. SBP cut-off of ≥30mmHg considered for postural measurements using continuous BP monitors, the significance of this value needs to be evaluated.
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. izzati@ummc.edu.my.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. izzati@ummc.edu.my.
authors.forename: Nor Izzati
authors.initials: NI
authors.lastname: Saedon
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Imran
authors.initials: I
authors.lastname: Zainal-Abidin
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Kok Han
authors.initials: KH
authors.lastname: Chee
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Hui Min
authors.initials: HM
authors.lastname: Khor
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Kit Mun
authors.initials: KM
authors.lastname: Tan
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Shahrul K
authors.initials: SK
authors.lastname: Kamaruzzaman
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Ai-Vyrn
authors.initials: AV
authors.lastname: Chin
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Philip J H
authors.initials: PJ
authors.lastname: Poi
authors.affiliation: Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. mptan@ummc.edu.my.|Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. mptan@ummc.edu.my.
authors.forename: Maw Pin
authors.initials: MP
authors.lastname: Tan
mesh_terms: D000058:Accidental Falls; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D004244:Dizziness / Q000209:etiology / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D011187:Posture; D013575:Syncope / Q000209:etiology / Q000503:physiopathology*
keywords: Accidental falls; Aged; Arrhythmia; Orthostatic hypotension; Syncope