Asymptomatic orthostatic hypotension and risk of falls in community-dwelling older people

Introduction Many older people with orthostatic hypotension (OH) may not report typical symptoms of dizziness, light-headedness or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established. Methods Continuous orthostatic blood pressure (BP) was measured during active stand using a Finometer at Wave 1 of The Irish Longitudinal Study on Ageing in participants aged >= 70 years. OH, with and without dizziness, was defined as a sustained drop in systolic BP >= 20 and/or diastolic BP >= 10 mm Hg at 30, 60 and 90 seconds post-standing. The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5). Results Almost 11% (n = 934, mean age 75 years, 51% female) had OH, two-thirds of whom were asymptomatic. Dizziness was not associated with systolic BP drop at 30 (beta = 1.54 (-1.27, 4.36); p = 0.256), 60 (beta = 2.64 (-0.19, 5.47); p = 0.476) or 90 seconds (beta = 2.02 (-0.91, 4.95); p = 0.176) after standing in adjusted models. Asymptomatic OH was independently associated with unexplained falls (odds ratio 2.01 [1.11, 3.65]; p = 0.022) but not explained falls (OR 0.93 [0.53, 1.62]; p = 0.797) during follow-up. Conclusions Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

Automated summary

Many older people with orthostatic hypotension may not experience typical symptoms of dizziness, light-headedness or unsteadiness. The association between orthostatic hypotension and falls in the absence of typical symptoms has not been established.