HYPOTENSION AND FALLS RISK IN HYPERTENSIVE OLDER ADULTS

Objective: Hypotension may increase the risk of falls in hypertensive older adults. Orthostatic hypotension (OH) and hypotensive episodes on ambulatory blood pressure monitoring (ABPM) are frequently underdiagnosed and their associated fall risk has been scarcely investigated. The aim of this study is to investigate the association of OH and hypotensive episodes on ABPM with fall risk in hypertensive older adults. Design and method: We enrolled hypertensive outpatients aged 75 or older, referred to the Hypertension and Memory Clinics of Careggi Hospital, Florence, who underwent multidimensional geriatric assessment, ABPM and standing blood pressure (BP) measurement. Follow-up was conducted with phone interviews at 12 months. Hypotensive episodes were defined when at least 1 daytime systolic BP measure was <90 mmHg (HYPO-90) or < 100 mmHg (HYPO-100) on ABPM. Associations with falls risk were investigated using multivariable logistic regression. Results: Among 120 participants (mean age 81 years, 58% female), 52 (43%) reported OH, 49 (41%) had HYPO-100 and 20 (17%) had HYPO-90. At the follow-up (median duration 12 months), 25 (21%) reported at least 1 fall. These subjects were older (83.7±5 vs 80.5±4 years, p<0.001), more frequently reported a history of falls (76% vs 35%, p<0.001) and showed a higher prevalence of dementia (67% vs 40%, p<0.001) and reduced physical performance (60% vs 34%, p=0.019). Moreover, participants with falls, more frequently showed disability in basic (36% vs 13%, p=0.009) and instrumental activities of daily living (76% vs 45%, p=0.006. Symptomatic OH and hypotensive episodes were associated with higher fall risk (Symptomatic OH p=0.033, HYPO-90 p=0.004, HYPO-100 p=0.003) At multivariate analysis, HYPO-100 predicted risk of falls independently of age, gender, and physical performance. OH and HYPO-100 were associated with fall risk independently of 24h-mean systolic BP. No association emerged between HYPO-90 and falls risk. Conclusions: Symptomatic orthostatic hypotension and hypotensive episodes <100 mmHg are common in older hypertensive outpatients and independently predict fall risk.