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Medientyp:
E-Artikel
Titel:
Abstract 49: Supine Versus Seated Positions On The Detection Of Orthostatic Hypotension And Its Association With Fall Risk And Orthostatic Symptoms
Beteiligte:
Juraschek, Stephen P;
Appel, Lawrence J;
Miller, Edgar R
Beschreibung:
<jats:p>
<jats:bold>Background:</jats:bold>
Hypertension trials that monitor orthostatic hypotension (OH) compare standing to seated blood pressure (BP) rather than supine BP. We determined the impact of a supine vs seated position on OH prevalence and its relationship with fall risk and orthostatic symptoms.
</jats:p>
<jats:p>
<jats:bold>Methods:</jats:bold>
The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a randomized trial testing the effects of vitamin D3 dose on falls in adults age ≥70 years at higher risk of falls. OH was determined at baseline, 3, 12, and 24 months with each of 2 protocols: (1) seated to standing and (2) supine to standing. OH was defined as a drop in systolic or diastolic BP of at least 20 or 10 mm Hg. Participants were asked about orthostatic symptoms in the past month. Falls were ascertained via daily fall calendar, ad hoc reporting, and scheduled interviews.
</jats:p>
<jats:p>
<jats:bold>Results:</jats:bold>
Among 522 participants with 953 OH assessments (mean age 76 ± 5 years, 42% women, 18% Black), mean baseline BP was 129 ± 18/68 ± 11 mm Hg. Mean BP increased 3.4/2.6 mm Hg after sitting, but decreased -3.7/-0.7 mm Hg after being supine. OH was detected in 2.2% of seated vs 14.8% of supine assessments. Supine OH better predicted falls (HR 1.60; 95% CI: 0.98, 2.61;
<jats:italic>P</jats:italic>
=0.06) than seated OH (HR 0.70; 95% CI: 0.30, 1.60;
<jats:italic>P</jats:italic>
=0.39), although both were non-significant (
<jats:bold>Figure</jats:bold>
). While seated OH was not associated with orthostatic symptoms, supine OH was associated with a greater risk of fainting, blacking out, seeing spots, room spinning, and headache in the prior month (
<jats:italic>P</jats:italic>
-values of 0.048 to 0.002).
</jats:p>
<jats:p>
<jats:bold>Conclusions:</jats:bold>
Supine OH was more prevalent and appeared to better predict falls and orthostatic symptoms than seated OH. These findings support a supine protocol for OH in clinical practice.
</jats:p>
<jats:p>
<jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" orientation="portrait" position="float" xlink:href="g299.jpg" />
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