The Prevalence of Orthostatic Hypotension: A Systematic Review and Meta-Analysis

Overview

Journal J Gerontol A Biol Sci Med Sci

Specialty Geriatrics

Date 2018 Sep 1

PMID 30169579

Citations 49

Authors

Nor Izzati Saedon

Maw Pin Tan

James Frith

Affiliations

Soon will be listed here.

Abstract

Background: Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to be common in older people, estimates of its prevalence vary widely. This study aims to address this by pooling the results of epidemiological studies.

Methods: MEDLINE, EMBASE, PubMed, Web of Science, and ProQuest were searched. Studies were included if participants were more than 60 years, were set within the community or within long-term care and diagnosis was based on a postural drop in systolic blood pressure (BP) ≥20 mmHg or diastolic BP ≥10 mmHg. Data were extracted independently by two reviewers. Random and quality effects models were used for pooled analysis.

Results: Of 23,090 identified records, 20 studies were included for community-dwelling older people (n = 24,967) and six were included for older people in long-term settings (n = 2,694). There was substantial variation in methods used to identify OH with differing supine rest duration, frequency and timing of standing BP, measurement device, use of standing and tilt-tables and interpretation of the diagnostic drop in BP. The pooled prevalence of OH in community-dwelling older people was 22.2% (95% CI = 17, 28) and 23.9% (95% CI = 18.2, 30.1) in long-term settings. There was significant heterogeneity in both pooled results (I2 > 90%).

Conclusions: OH is very common, affecting one in five community-dwelling older people and almost one in four older people in long-term care. There is great variability in methods used to identify OH.

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References

Low P, Opfer-Gehrking T, McPhee B, Fealey R, Benarroch E, Willner C . Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995; 70(7):617-22. DOI: 10.4065/70.7.617. View

Gangavati A, Hajjar I, Quach L, Jones R, Kiely D, Gagnon P . Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc. 2011; 59(3):383-9. PMC: 3306056. DOI: 10.1111/j.1532-5415.2011.03317.x. View

Menant J, Wong A, Trollor J, Close J, Lord S . Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community-Living Older People. J Am Geriatr Soc. 2016; 64(5):1073-8. DOI: 10.1111/jgs.14104. View

Ooi W, Barrett S, Hossain M, Lipsitz L . Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA. 1997; 277(16):1299-304. View

Fagard R, De Cort P . Orthostatic hypotension is a more robust predictor of cardiovascular events than nighttime reverse dipping in elderly. Hypertension. 2010; 56(1):56-61. DOI: 10.1161/HYPERTENSIONAHA.110.151654. View

Graafmans W, Ooms M, Hofstee H, Bezemer P, Bouter L, Lips P . Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996; 143(11):1129-36. DOI: 10.1093/oxfordjournals.aje.a008690. View

Valbusa F, Labat C, Salvi P, Vivian M, Hanon O, Benetos A . Orthostatic hypotension in very old individuals living in nursing homes: the PARTAGE study. J Hypertens. 2011; 30(1):53-60. DOI: 10.1097/HJH.0b013e32834d3d73. View

van Hateren K, Kleefstra N, Blanker M, Ubink-Veltmaat L, Groenier K, Houweling S . Orthostatic hypotension, diabetes, and falling in older patients: a cross-sectional study. Br J Gen Pract. 2012; 62(603):e696-702. PMC: 3459777. DOI: 10.3399/bjgp12X656838. View

ODwyer C, Bennett K, Langan Y, Fan C, Kenny R . Amnesia for loss of consciousness is common in vasovagal syncope. Europace. 2011; 13(7):1040-5. DOI: 10.1093/europace/eur069. View

10.

Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C . Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012; 65(9):934-9. DOI: 10.1016/j.jclinepi.2011.11.014. View

11.

Hunter J, Saratzis A, Sutton A, Boucher R, Sayers R, Bown M . In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014; 67(8):897-903. DOI: 10.1016/j.jclinepi.2014.03.003. View

12.

Parry S, Steen I, Baptist M, Kenny R . Amnesia for loss of consciousness in carotid sinus syndrome: implications for presentation with falls. J Am Coll Cardiol. 2005; 45(11):1840-3. DOI: 10.1016/j.jacc.2005.02.060. View

13.

Fisher A, Davis M, Srikusalanukul W, Budge M . Postprandial hypotension predicts all-cause mortality in older, low-level care residents. J Am Geriatr Soc. 2005; 53(8):1313-20. DOI: 10.1111/j.1532-5415.2005.53415.x. View

14.

Hartog L, Schrijnders D, Landman G, Groenier K, Kleefstra N, Bilo H . Is orthostatic hypotension related to falling? A meta-analysis of individual patient data of prospective observational studies. Age Ageing. 2017; 46(4):568-575. PMC: 6402310. DOI: 10.1093/ageing/afx024. View

15.

Wolters F, Mattace-Raso F, Koudstaal P, Hofman A, Ikram M . Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLoS Med. 2016; 13(10):e1002143. PMC: 5058559. DOI: 10.1371/journal.pmed.1002143. View

16.

Rockwood M, Howlett S, Rockwood K . Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty. Arch Gerontol Geriatr. 2012; 54(3):e255-60. DOI: 10.1016/j.archger.2011.12.009. View

17.

Zia A, Kamaruzzaman S, Myint P, Tan M . The association of antihypertensives with postural blood pressure and falls among seniors residing in the community: a case-control study. Eur J Clin Invest. 2015; 45(10):1069-76. DOI: 10.1111/eci.12508. View

18.

Jansen R, Lipsitz L . Intraindividual reproducibility of postprandial and orthostatic blood pressure changes in older nursing-home patients: relationship with chronic use of cardiovascular medications. J Am Geriatr Soc. 1996; 44(4):383-9. DOI: 10.1111/j.1532-5415.1996.tb06406.x. View

19.

Freeman R, Wieling W, Axelrod F, Benditt D, Benarroch E, Biaggioni I . Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011; 21(2):69-72. DOI: 10.1007/s10286-011-0119-5. View

20.

Hakala S, Tilvis R . How stable is postural hypotension in the general aged population?. Arch Gerontol Geriatr. 1996; 23(2):129-38. DOI: 10.1016/0167-4943(96)00713-3. View