Is orthostatic hypotension related to falling? A meta-analysis of individual patient data of prospective observational studies.
orthostatic hypotension (OH) is one out of many risk factors believed to contribute to an increased fall risk in elderly subjects but it is unclear whether an independent association between OH and falling exists.



to perform an individual patient data (IPD) meta-analysis of prospective observational studies investigating the relationship between OH and falling.



MEDLINE, EMBASE, the Cochrane Library and the abstracts of annual meetings of selected hypertension societies were searched. Both one-stage (analysing all IPD from all studies simultaneously) and two-stage (analysing IPD per study, and then pooling the results) methods were used, and both logistic and cox regression analyses were performed. The study protocol was published on PROSPERO (2015:CRD42015019178).



from 34 selected abstracts, 6 studies were included. IPD were provided in 1,022 patients from 3 cohorts and were included in the IPD meta-analysis. The one-stage meta-analysis showed a significant relationship between OH and time to first fall incident (hazard ratio (HR) 1.52 (95% Confidence Interval (CI) 1.23-1.88)). No significant relationship between OH and falling was found in the one-stage logistic regression analysis and the two-stage logistic and cox regression analyses.



this IPD meta-analysis of prospective observational studies showed a clear and significant relationship between OH and time to first fall incident. Although the ORs of falling was not significantly different for patients with and without OH, a the cox regression analyses reporting HRs and including time to incident provided more clinically relevant information in present meta-analysis.
Diabetes Centre, Isala, PO Box 10400, Zwolle 8000 GK, The Netherlands.
Laura Caroline
LC
Hartog
Diabetes Centre, Isala, PO Box 10400, Zwolle 8000 GK, The Netherlands.|Langerhans Medical Research Group, The Netherlands.
Dennis
D
Schrijnders
Langerhans Medical Research Group, The Netherlands.|Gelre Ziekenhuizen - Internal Medicine, Apeldoorn, The Netherlands.
G W D
GWD
Landman
Diabetes Centre, Isala, PO Box 10400, Zwolle 8000 GK, The Netherlands.|Department of General Practice - University Medical Center Groningen, Groningen, The Netherlands.
Klaas
K
Groenier
Langerhans Medical Research Group, The Netherlands.|Langerhans Medical Research Group, Universitair Medisch Centrum Groningen - Internal medicine, Groningen, The Netherlands.
Nanne
N
Kleefstra
Diabetes Centre, Isala, PO Box 10400, Zwolle 8000 GK, The Netherlands.|Department of Internal Medicine - University Medical Center Groningen, Groningen, The Netherlands.|Isala - Internal Medicine, Zwolle, The Netherlands.
Henk J G
HJG
Bilo
Langerhans Medical Research Group, Zwolle, The Netherlands.
Kornelis Johannes Jongers
KJJ
van Hateren
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D064887:Observational Studies as Topic; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
Orthostatic hypotension; fall-risk; individual patient data; meta-analysis, older people