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Midlife Orthostatic Hypotension Predicts Later Falls in ARIC

In the large sample of 40- to 60-year-old community-dwelling adults in the Atherosclerosis Risk in Communities (ARIC) study, those who had orthostatic (postural) hypotension were more likely to fall within the next 2 decades, especially if they had diastolic postural hypotension, independent of other risk factors.

The data was presented  at the recent American Heart Association Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (EPI|Lifestyle) 2016 Scientific Sessions.

The current study suggests that diastolic postural hypotension is a stronger predictor, and the relationship between a drop in blood pressure and an increased risk of a fall is a continuous one, as opposed to having a single threshold.

This study is important because falls are really detrimental with a lot of negative sequelae. It"s not just expense; it"s not just fractures; it causes a whole cascade, a negative spiral, once an older adult has a fall.

They aimed, first, to determine whether orthostatic hypotension in midlife predicts the risk of a future fall, and second, to characterize how postural changes in systolic and diastolic blood pressure affect this risk.

The researchers investigated this in 12,661 adults who had a mean age of 54 in 1987–1989 when they enrolled in the prospective ARIC study. During a 23-year follow-up, there were 2274 falls. More falls occurred in the participants with vs without postural hypotension (2.8 falls per 1000 person-years vs 2.3 falls per 1000 person-years, P=0.03).

Participants with postural hypotension were 25% more likely to fall than those without postural hypotension (HR 1.25, 95% CI 1.04–1.49), after adjustment for demographics (age, sex, race, education), resting systolic and diastolic blood pressures, other health measures.