Postural Blood Pressure Recovery and Recurrent Falls Among Community-Dwelling Older Adults: A Prospective Cohort Study
Delayed Postural Blood Pressure Recovery and Recurrent Falls
DOI:
https://doi.org/10.69750/dmls.03.07.0221Keywords:
Accidental falls, blood pressure, orthostatic hypotension, postural balance, AgedAbstract
Background: Recurrent falls cause disability and dependence among older adults. Conventional orthostatic assessment may overlook delayed systolic blood pressure recovery during the first minute after standing.
Objective: To determine whether delayed systolic blood pressure recovery after active standing is associated with recurrent falls among community-dwelling older adults.
Methods: This prospective cohort study was conducted at Continental Medical College, Lahore, Punjab, Pakistan, from February 2024 to February 2026. One hundred adults aged 65 years or older were recruited between February 2024 and February 2025 and followed for 12 months. After 10 minutes of supine rest, blood pressure was measured at baseline and at 30 seconds, 60 seconds, and three minutes after active standing. Delayed recovery was defined a priori as systolic blood pressure remaining at least 10 mmHg below the supine baseline at 60 seconds. Falls were recorded prospectively using monthly fall calendars and telephone interviews. Recurrent falls were defined as two or more falls during follow-up. Adjusted risk ratios were estimated using modified Poisson regression with robust standard errors.
Results: Delayed recovery was identified in 34 participants. Recurrent falls occurred in 15 of 34 participants with delayed recovery and 8 of 66 with normal recovery (44.1% versus 12.1%). Delayed recovery remained independently associated with recurrent falls after multivariable adjustment (adjusted risk ratio 2.73; 95% confidence interval 1.29–5.77; p=0.009).
Conclusion: Delayed systolic blood pressure recovery at 60 seconds was independently associated with recurrent falls. Early postural blood pressure measurements may complement conventional orthostatic assessment and improve fall-risk identification in older adults.
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Colón-Emeric CS, McDermott CL, Lee DS, Berry SD. Risk assessment and prevention of falls in older community-dwelling adults: a review. JAMA. 2024;331(16):1397-1406. doi:10.1001/jama.2024.1416.
Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205. doi:10.1093/ageing/afac205.
Wieling W, Kaufmann H, Claydon VE, van Wijnen VK, Harms MPM, Juraschek SP, et al. Diagnosis and treatment of orthostatic hypotension. Lancet Neurol. 2022;21(8):735-746. doi:10.1016/S1474-4422(22)00169-7.
Juraschek SP, Cortez MM, Flack JM, Ghazi L, Kenny RA, Rahman M, et al. Orthostatic hypotension in adults with hypertension: a scientific statement from the American Heart Association. Hypertension. 2024;81(3):e16-e30. doi:10.1161/HYP.0000000000000236.
Saedon NI, Tan MP, Frith J. The prevalence of orthostatic hypotension: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2020;75(1):117-122. doi:10.1093/gerona/gly188.
Tran J, Hillebrand SL, Meskers CGM, Iseli RK, Maier AB. Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50(5):1520-1528. doi:10.1093/ageing/afab090.
Mol A, Slangen LRN, van Wezel RJA, Maier AB, Meskers CGM. Orthostatic blood pressure recovery associates with physical performance, frailty and number of falls in geriatric outpatients. J Hypertens. 2021;39(1):101-106. doi:10.1097/HJH.0000000000002617.
Mol A, Bui Hoang PTS, Sharmin S, Reijnierse EM, van Wezel RJA, Meskers CGM, et al. Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20(5):589-597.e5. doi:10.1016/j.jamda.2018.11.003.
Hohtari-Kivimäki U, Salminen M, Vahlberg T, Kivelä SL. Orthostatic hypotension is a risk factor for falls among older adults: 3-year follow-up. J Am Med Dir Assoc. 2021;22(11):2325-2330. doi:10.1016/j.jamda.2021.07.010.
Duggan E, Knight SP, Romero-Ortuno R. Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees. Eur Geriatr Med. 2023;14(3):439-446. doi:10.1007/s41999-023-00775-0.
Wang L, van Poelgeest EP, Klop M, Claassen JAHR, Hoekstra AG, van der Velde N. Beat-to-beat blood pressure monitoring and orthostatic hypotension-related falls in two cohorts of older adults. Geriatrics (Basel). 2025;10(4):102. doi:10.3390/geriatrics10040102.
Bourke R, Doody P, Perez S, Moloney D, Lipsitz L, Kenny RA. Cardiovascular disorders and falls among older adults: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2024;79(2):glad221. doi:10.1093/gerona/glad221.
Finucane C, van Wijnen VK, Fan CW, Soraghan C, Byrne L, Westerhof BE, et al. A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring. Clin Auton Res. 2019;29(4):427-441. doi:10.1007/s10286-019-00606-y.
Donoghue OA, O’Connell MDL, Bourke R, Kenny RA. Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing. PLoS One. 2021;16(5):e0252212. doi:10.1371/journal.pone.0252212.
Juraschek SP, Appel LJ, Mitchell CM, Mukamal KJ, Lipsitz LA, Blackford AL, et al. Comparison of supine and seated orthostatic hypotension assessments and their association with falls and orthostatic symptoms. J Am Geriatr Soc. 2022;70(8):2310-2319. doi:10.1111/jgs.17804.
Finucane C, O’Connell MDL, Donoghue O, Richardson K, Savva GM, Kenny RA. Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls. J Am Geriatr Soc. 2017;65(3):474-482. doi:10.1111/jgs.14563.
Doyle K, Lavan A, Kenny RA, Briggs R. Delayed blood pressure recovery after standing independently predicts fracture in community-dwelling older people. J Am Med Dir Assoc. 2021;22(6):1235-1241.e1. doi:10.1016/j.jamda.2020.12.031.
Mol A, Slangen LRN, Trappenburg MC, Reijnierse EM, van Wezel RJA, Meskers CGM, et al. Blood pressure drop rate after standing up is associated with frailty and number of falls in geriatric outpatients. J Am Heart Assoc. 2020;9(7):e014688. doi:10.1161/JAHA.119.014688.
Fedorowski A, Ricci F, Hamrefors V, Sandau KE, Chung TH, Muldowney JAS, et al. Orthostatic hypotension: management of a complex, but common, medical problem. Circ Arrhythm Electrophysiol. 2022;15(3):e010573. doi:10.1161/CIRCEP.121.010573.
Rivasi G, Rafanelli M, Mossello E, Brignole M, Ungar A. Drug-related orthostatic hypotension: beyond anti-hypertensive medications. Drugs Aging. 2020;37(10):725-738. doi:10.1007/s40266-020-00796-5.
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