Delayed Blood Pressure Recovery After Standing Independently Predicts Fracture in Community-Dwelling Older People

Objectives: Orthostatic hypotension, characterized by delayed blood pressure (BP) recovery after standing, is a risk factor for falls but the longitudinal relationship with fracture is not yet known. The aim of this study was to examine the prospective risk of fracture associated with delayed BP recovery. Design: Longitudinal study with 8-year follow-up. Setting and Participants: More than 3000 (54% female) community-dwelling people aged > 50 years from a large longitudinal study on ageing. Methods: Orthostatic BP was measured using a finometer when standing from lying. Delayed BP recovery was defined as systolic BP > 20 mm Hg lower and/or diastolic BP > 10 mm Hg from the baseline value at 30, 60, and 90 seconds after standing. Participants with a fracture reported at any of waves 2 to 5 were defined as having incident fracture. Logistic regression models were used to estimate odds ratios (ORs) for the association between delayed BP recovery and incident fracture. Results: Seven percent (212/3117) of participants sustained a fracture during follow-up. Delayed BP recovery at 30 seconds was a significant predictor of any fracture [OR 1.80, 95% confidence interval (CI) 1.28-2.53] and hip fracture (OR 4.44, 95% CI 2.03-9.71) in fully adjusted models. Delayed BP recovery at 30 seconds did not predict wrist or vertebral fracture. Delayed BP recovery at 60 seconds also predicted any fracture (OR 1.74, 95% CI 1.19-2.54) and hip fracture (OR 4.66, 95% CI 2.12-10.26) whereas delayed BP recovery at 90 seconds predicted any (OR 1.99, 95% CI 1.38-2.87), wrist (OR 1.87, 95% CI 1.19-2.95), and hip fracture (OR 3.39, 95% CI 1.45-7.93) in fully adjusted models. Conclusion: and Implications: Delayed BP recovery independently predicts fracture in community dwelling older people, is potentially modifiable, and can be measured in an ambulatory setting. Because of the morbidity and mortality associated with fractures, identification of such risk factors is crucial in order to inform preventative strategies. (c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine.