Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: The maintenance of balance, independent living, intellect, and zest in the elderly of Boston study

Anupama Gangavati, Ihab Hajjar, Lien Quach, Richard N. Jones, Dan K. Kiely, Peggy Gagnon, Lewis A. Lipsitz

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

OBJECTIVES: To investigate the relationships between uncontrolled and controlled hypertension, orthostatic hypotension (OH), and falls in participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study (N=722, mean age 78.1). DESIGN: Prospective population-based study. SETTING: Community. PARTICIPANTS: Seven hundred twenty-two adults aged 70 and older living within a 5-mile radius of the study headquarters at Hebrew Rehabilitation Center in Boston. MEASUREMENTS: Blood pressure (BP) was measured at baseline in the supine position and after 1 and 3 minutes of standing. Systolic OH (SOH) and diastolic OH at 1 and 3 minutes were defined as a 20-mmHg decline in systolic BP and a 10-mmHg decline in diastolic BP upon standing. Hypertension was defined as BP of 140/90mmHg or greater or receiving antihypertensive medications (controlled if BP<140/90mmHg and uncontrolled if ≥140/90 mmHg). Falls data were prospectively collected using monthly calendars. Fallers were defined as those with at least two falls within 1 year of follow-up. RESULTS: OH was highest in participants with uncontrolled hypertension; SOH at 1 minute was 19% in participants with uncontrolled hypertension, 5% in those with controlled hypertension, and 2% in those without hypertension (P≤.001)). Participants with SOH at 1 minute and uncontrolled hypertension were at greater risk of falls (hazard ratio=2.5, 95% confidence interval=1.3-5.0) than those with uncontrolled hypertension without OH. OH by itself was not associated with falls. CONCLUSION: Older adults with uncontrolled hypertension and SOH at 1 minute are at greater risk for falling within 1 year. Hypertension control, with or without OH, is not associated with greater risk of falls in older community-dwelling adults.

Original languageEnglish (US)
Pages (from-to)383-389
Number of pages7
JournalJournal of the American Geriatrics Society
Volume59
Issue number3
DOIs
StatePublished - Mar 1 2011
Externally publishedYes

Fingerprint

Independent Living
Orthostatic Hypotension
Maintenance
Hypertension
Blood Pressure
Population
Rehabilitation Centers
Supine Position
Antihypertensive Agents
Confidence Intervals

Keywords

  • Elderly
  • Falls
  • Hypertension
  • Orthostatic hypotension

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population : The maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. / Gangavati, Anupama; Hajjar, Ihab; Quach, Lien; Jones, Richard N.; Kiely, Dan K.; Gagnon, Peggy; Lipsitz, Lewis A.

In: Journal of the American Geriatrics Society, Vol. 59, No. 3, 01.03.2011, p. 383-389.

Research output: Contribution to journalArticle

@article{36729dfa41664a309833ca8f998a626c,
title = "Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: The maintenance of balance, independent living, intellect, and zest in the elderly of Boston study",
abstract = "OBJECTIVES: To investigate the relationships between uncontrolled and controlled hypertension, orthostatic hypotension (OH), and falls in participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study (N=722, mean age 78.1). DESIGN: Prospective population-based study. SETTING: Community. PARTICIPANTS: Seven hundred twenty-two adults aged 70 and older living within a 5-mile radius of the study headquarters at Hebrew Rehabilitation Center in Boston. MEASUREMENTS: Blood pressure (BP) was measured at baseline in the supine position and after 1 and 3 minutes of standing. Systolic OH (SOH) and diastolic OH at 1 and 3 minutes were defined as a 20-mmHg decline in systolic BP and a 10-mmHg decline in diastolic BP upon standing. Hypertension was defined as BP of 140/90mmHg or greater or receiving antihypertensive medications (controlled if BP<140/90mmHg and uncontrolled if ≥140/90 mmHg). Falls data were prospectively collected using monthly calendars. Fallers were defined as those with at least two falls within 1 year of follow-up. RESULTS: OH was highest in participants with uncontrolled hypertension; SOH at 1 minute was 19{\%} in participants with uncontrolled hypertension, 5{\%} in those with controlled hypertension, and 2{\%} in those without hypertension (P≤.001)). Participants with SOH at 1 minute and uncontrolled hypertension were at greater risk of falls (hazard ratio=2.5, 95{\%} confidence interval=1.3-5.0) than those with uncontrolled hypertension without OH. OH by itself was not associated with falls. CONCLUSION: Older adults with uncontrolled hypertension and SOH at 1 minute are at greater risk for falling within 1 year. Hypertension control, with or without OH, is not associated with greater risk of falls in older community-dwelling adults.",
keywords = "Elderly, Falls, Hypertension, Orthostatic hypotension",
author = "Anupama Gangavati and Ihab Hajjar and Lien Quach and Jones, {Richard N.} and Kiely, {Dan K.} and Peggy Gagnon and Lipsitz, {Lewis A.}",
year = "2011",
month = "3",
day = "1",
doi = "10.1111/j.1532-5415.2011.03317.x",
language = "English (US)",
volume = "59",
pages = "383--389",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population

T2 - The maintenance of balance, independent living, intellect, and zest in the elderly of Boston study

AU - Gangavati, Anupama

AU - Hajjar, Ihab

AU - Quach, Lien

AU - Jones, Richard N.

AU - Kiely, Dan K.

AU - Gagnon, Peggy

AU - Lipsitz, Lewis A.

PY - 2011/3/1

Y1 - 2011/3/1

N2 - OBJECTIVES: To investigate the relationships between uncontrolled and controlled hypertension, orthostatic hypotension (OH), and falls in participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study (N=722, mean age 78.1). DESIGN: Prospective population-based study. SETTING: Community. PARTICIPANTS: Seven hundred twenty-two adults aged 70 and older living within a 5-mile radius of the study headquarters at Hebrew Rehabilitation Center in Boston. MEASUREMENTS: Blood pressure (BP) was measured at baseline in the supine position and after 1 and 3 minutes of standing. Systolic OH (SOH) and diastolic OH at 1 and 3 minutes were defined as a 20-mmHg decline in systolic BP and a 10-mmHg decline in diastolic BP upon standing. Hypertension was defined as BP of 140/90mmHg or greater or receiving antihypertensive medications (controlled if BP<140/90mmHg and uncontrolled if ≥140/90 mmHg). Falls data were prospectively collected using monthly calendars. Fallers were defined as those with at least two falls within 1 year of follow-up. RESULTS: OH was highest in participants with uncontrolled hypertension; SOH at 1 minute was 19% in participants with uncontrolled hypertension, 5% in those with controlled hypertension, and 2% in those without hypertension (P≤.001)). Participants with SOH at 1 minute and uncontrolled hypertension were at greater risk of falls (hazard ratio=2.5, 95% confidence interval=1.3-5.0) than those with uncontrolled hypertension without OH. OH by itself was not associated with falls. CONCLUSION: Older adults with uncontrolled hypertension and SOH at 1 minute are at greater risk for falling within 1 year. Hypertension control, with or without OH, is not associated with greater risk of falls in older community-dwelling adults.

AB - OBJECTIVES: To investigate the relationships between uncontrolled and controlled hypertension, orthostatic hypotension (OH), and falls in participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study (N=722, mean age 78.1). DESIGN: Prospective population-based study. SETTING: Community. PARTICIPANTS: Seven hundred twenty-two adults aged 70 and older living within a 5-mile radius of the study headquarters at Hebrew Rehabilitation Center in Boston. MEASUREMENTS: Blood pressure (BP) was measured at baseline in the supine position and after 1 and 3 minutes of standing. Systolic OH (SOH) and diastolic OH at 1 and 3 minutes were defined as a 20-mmHg decline in systolic BP and a 10-mmHg decline in diastolic BP upon standing. Hypertension was defined as BP of 140/90mmHg or greater or receiving antihypertensive medications (controlled if BP<140/90mmHg and uncontrolled if ≥140/90 mmHg). Falls data were prospectively collected using monthly calendars. Fallers were defined as those with at least two falls within 1 year of follow-up. RESULTS: OH was highest in participants with uncontrolled hypertension; SOH at 1 minute was 19% in participants with uncontrolled hypertension, 5% in those with controlled hypertension, and 2% in those without hypertension (P≤.001)). Participants with SOH at 1 minute and uncontrolled hypertension were at greater risk of falls (hazard ratio=2.5, 95% confidence interval=1.3-5.0) than those with uncontrolled hypertension without OH. OH by itself was not associated with falls. CONCLUSION: Older adults with uncontrolled hypertension and SOH at 1 minute are at greater risk for falling within 1 year. Hypertension control, with or without OH, is not associated with greater risk of falls in older community-dwelling adults.

KW - Elderly

KW - Falls

KW - Hypertension

KW - Orthostatic hypotension

UR - http://www.scopus.com/inward/record.url?scp=79952548396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952548396&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2011.03317.x

DO - 10.1111/j.1532-5415.2011.03317.x

M3 - Article

C2 - 21391928

AN - SCOPUS:79952548396

VL - 59

SP - 383

EP - 389

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 3

ER -