title: Orthostatic Hypotension in Middle-Age and Risk of Falls.
abstract: BACKGROUND
  One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent.
  
  
  METHODS
  We conducted a prospective study of the association between baseline OH (1987-1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20mm Hg or diastolic blood pressure (DBP) ≥10mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables.
  
  
  RESULTS
  During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per -5mm Hg change in DBP; 95% CI: 1.05, 1.13; P < 0.001) than postural change in SBP (HR 1.03 per -5mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002).
  
  
  CONCLUSIONS
  In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls.
authors.affiliation: The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Juraschek
authors.affiliation: The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Daya
authors.affiliation: The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.affiliation: University of Mississippi Medical Center Department of Medicine and Center of Biostatistics, Jackson, Mississippi, USA.
authors.forename: Beverly Gwen
authors.initials: BG
authors.lastname: Windham
authors.affiliation: University of Texas School of Public Health, Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Pompeii
authors.affiliation: University of Mississippi Medical Center Department of Medicine and Center of Biostatistics, Jackson, Mississippi, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.affiliation: University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
authors.affiliation: The Johns Hopkins School of Medicine Department of Medicine, The Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, The Welch Center for Prevention, Epidemiology and Clinical Research, and Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; lselvin@jhsph.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: ARIC; blood pressure; epidemiology; fall; hypertension; orthostatic hypotension; prospective cohort.