Jacobs journal of gerontology最新文献

英文中文

Falls and Orthostatic Hypotension in Older Adults: Re-examining Limits. 老年人跌倒和直立性低血压:重新检查限度。

Jacobs journal of gerontology

Pub Date : 2017-08-01 Epub Date: 2017-05-23

Alycia Cleinman, Michael E Griswold, Eleanor M Simonsick, W Mark Meeks, Katharine T Gregg, Luigi Ferrucci, B Gwen Windham

Background: Orthostatic hypotension (OH) is defined using substantial thresholds of blood pressure (BP) drops with standing, which may be insufficient for identifying falls risk.

Objective: To assess associations between falls risk and (1) consensus-defined OH (cOH), (2) standing BP levels, (3) BP changes with standing, (4) combined standing BP levels and BP changes with standing.

Design: Observational study of normative aging.

Setting: Baltimore Longitudinal Study of Aging.

Participants: Participants ≥65 years with first visits evaluating OH and self-reported falls (2004-2010).

Measurements: BP was measured supine and 3 minutes after standing. A drop in systolic BP (SBP) ≥20mmHg or a drop in diastolic BP (DBP) ≥10mmHg upon standing defined cOH. Participants self-reported the number of falls experienced in the previous 12 months.

Results: Among 400 participants (45% women; 30% black; mean age 74.8 years), 113 (28%) reported ≥1 fall; 19 (4.8%) had cOH. In adjusted models, cOH (OR=2.77, 95% CI: 1.00-7.71 p=0.051) and continuous SBP-drops per 5mmHg (OR=1.21, 1.00-1.47 p=0.046) were associated with having any fall and multiple falls (cOH: OR=3.94, 1.04-14.96 p=0.044; SBP 5mmHg drops: OR=1.34, 1.00-2.15 p=0.020). Attained SBP with standing was not associated with falls either alone (OR=1.01, 0.99-1.02 p=0.369) or in combination with SBP-drops (interaction OR=1.03, 0.96-1.09 p=0.414).

Limitations: Cross-sectional design, prohibiting conclusions about causal relationships.

Conclusions: Findings suggest that postural SBP-drops that are much lower than current OH definition thresholds indicate increased falls risk in older adults, regardless of absolute SBP level. This has implications for standard clinical falls risk assessment and communication of falls risk to patients.

背景:直立性低血压(OH)是根据站立时血压(BP)下降的阈值来定义的，这可能不足以识别跌倒风险。目的:评估跌倒风险与(1)共识定义的OH (cOH)、(2)站立时血压水平、(3)站立时血压变化、(4)联合站立时血压水平和站立时血压变化之间的关系。设计:规范衰老的观察性研究。背景:巴尔的摩老龄化纵向研究。参与者:年龄≥65岁，首次就诊评估OH和自我报告跌倒(2004-2010)。测量方法:仰卧位和站立后3分钟测量血压。收缩压(SBP)下降≥20mmHg或舒张压(DBP)下降≥10mmHg。参与者自我报告了在过去12个月里跌倒的次数。结果:在400名参与者中(45%为女性;30%是黑人;平均年龄74.8岁)，113例(28%)报告≥1次跌倒;cOH 19例(4.8%)。在调整后的模型中，cOH (OR=2.77, 95% CI: 1.00-7.71 p=0.051)和每5mmHg连续的sbp下降(OR=1.21, 1.00-1.47 p=0.046)与任何跌倒和多次跌倒相关(cOH: OR=3.94, 1.04-14.96 p=0.044;收缩压5mmHg下降:OR=1.34, 1.00-2.15 p=0.020)。站立时获得的收缩压与跌倒无关(OR=1.01, 0.99-1.02 p=0.369)或与收缩压下降联合(交互作用OR=1.03, 0.96-1.09 p=0.414)。局限性:横断面设计，禁止因果关系的结论。结论:研究结果表明，无论绝对收缩压水平如何，体位性收缩压下降远低于当前OH定义阈值表明老年人跌倒风险增加。这对标准的临床跌倒风险评估和向患者传达跌倒风险具有重要意义。

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