P081 ASSOCIATION BETWEEN 24-HOUR BLOOD PRESSURE VARIABILITY AND FALLS

Background and Objective: Clinicians may worry that fluctuations in blood pressure (BP) put older adults at risk for falling. While many adults taking antihypertensive medication have high BP variability (BPV), associations between higher BPV and risk of falls among older adults taking antihypertensive medication are unknown. Methods: We conducted a prospective cohort study of adults ≥65 years old taking antihypertensive medication recruited from a US integrated healthcare system. Information on demographics, clinical characteristics, geriatric assessments, mean clinic BP, and 24-hour ambulatory BP monitoring was collected at a baseline visit. Participants recorded falls over one year using monthly falls calendars. BPV was assessed as 24-hour standard deviation (SD) weighted for day-night BP. Participants were grouped into quartiles of 24-hour SD of systolic BP (SBP) and diastolic BP (DBP), respectively. We used multivariable Cox proportional hazards models to examine the association between BPV and time to first fall comparing the highest quartile to the three lower quartiles of these BPV measures. Results: We analyzed 608 participants [mean age 74.6 years, 14% Asian/Pacific Islander, 22% Black, 18% Hispanic, 45% White, and 57% female]. During follow-up, 238 participants (39%) experienced at least one fall. The incidence rate per 100 person-years of falls was 52.2 (95% CI, 44.9-60.6) in the lower quartiles of SBP variability and 65.0 (51.1-82.7) in the highest quartile. Higher 24-hour BPV was not associated with a higher risk of falls in the overall population (adjusted HR 1.17, 95% CI 0.86-1.58 for SBP and 1.09, 95% CI 0.81-1.48 for DBP). The results did not differ across subgroups defined by age, sex, race and ethnicity, and history of falls. However, higher BPV among individuals with clinic SBP ≥140 mmHg at baseline was associated with an increased risk of falls (Table). Conclusions: In this study of older adults with treated hypertension, higher BPV was associated with a two-fold increased risk of falls only among adults with clinic SBP ≥140 mmHg at baseline.