OBJECTIVES: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). DESIGN: Cross-sectional. SETTING: Geriatric research clinic. PARTICIPANTS: Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. MEASUREMENTS: Active lying-to-standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline - nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5-second averages method and entered in K-means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). RESULTS: The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH- (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH- (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005). CONCLUSION: It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people.
OBJECTIVES: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). DESIGN: Cross-sectional. SETTING: Geriatric research clinic. PARTICIPANTS: Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. MEASUREMENTS: Active lying-to-standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline - nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5-second averages method and entered in K-means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). RESULTS: The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH- (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH- (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005). CONCLUSION: It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people.
Authors: Paul Muntner; Paula T Einhorn; William C Cushman; Paul K Whelton; Natalie A Bello; Paul E Drawz; Beverly B Green; Daniel W Jones; Stephen P Juraschek; Karen L Margolis; Edgar R Miller; Ann Marie Navar; Yechiam Ostchega; Michael K Rakotz; Bernard Rosner; Joseph E Schwartz; Daichi Shimbo; George S Stergiou; Raymond R Townsend; Jeff D Williamson; Jackson T Wright; Lawrence J Appel Journal: J Am Coll Cardiol Date: 2019-01-29 Impact factor: 24.094
Authors: Nor Izzati Saedon; Imran Zainal-Abidin; Kok Han Chee; Hui Min Khor; Kit Mun Tan; Shahrul K Kamaruzzaman; Ai-Vyrn Chin; Philip J H Poi; Maw Pin Tan Journal: Clin Auton Res Date: 2015-12-22 Impact factor: 4.435
Authors: Stephen P Juraschek; Lawrence J Appel; Edgar R Miller; Kenneth J Mukamal; Lewis A Lipsitz Journal: Hypertension Date: 2018-10 Impact factor: 10.190