Eight Orthostatic Haemodynamic Patterns in The Irish Longitudinal Study on Ageing (TILDA): Stability and Clinical Associations after 4 Years.

David Moloney,Louise Newman,Roman Romero-Ortuno,Silvin P Knight,Rose Anne Kenny

doi:10.3390/geriatrics6020050

David Moloney, Louise Newman + Show 3 more

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https://doi.org/10.3390/geriatrics6020050

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Abstract

Previous research cross-sectionally characterised eight morphological systolic blood pressure (SBP) active stand (AS) patterns using a clinical clustering approach at Wave 1 (W1) of the Irish Longitudinal Study on Ageing. We explored the longitudinal stability and clinical associations of these groupings at Wave 3 (W3), four years later. Eight AS groups had their clinical characteristics and AS patterns at W3 compared to W1. We explored longitudinal associations (new cognitive decline, falls, syncope, disability, and mortality) using multivariate logistic regression models. In total, 2938 participants (60% of Wave 1 sample) had adequate AS data from both W1 and 3 for analysis. We found no longitudinal stability of the eight AS groups or their morphological patterns between the waves. A pattern of impaired stabilisation and late deficit seemed more preserved and was seen in association with new cognitive decline (OR 1.63, 95% CI: 1.12–2.36, p = 0.011). An increase in antihypertensive usage seemed associated with reduced immediate SBP drops, improved AS patterns, and reduced orthostatic intolerance (OI). In pure longitudinal groups, AS patterns were not preserved after 4 years. AS patterns are longitudinally dynamic, and improvements after 4 years are possible even in the presence of higher antihypertensive burden.

Highlights

We observed common patterns of ageing across all groups with increasing levels of polypharmacy [23] and multimorbidity [24]; overall, our results suggest a healthier response in Wave 3 (W3) compared to the same Wave 1 (W1) participants
We found no longitudinal stability of the eight active stand (AS) patterns four years later and this study echoes similar findings found by Finucane et al with the Irish SHARE cohort [8]
Our study found that there is no longitudinal stability of the eight AS

Summary

Introduction

Orthostatic Hypotension (OH) is traditionally defined as a reduction in systolic blood pressure (SBP) of at least 20 mmHg or diastolic blood pressure (DBP) of at least 10 mmHg within 3 min of standing [1]. This definition is based on intermittent blood pressure measurements via sphygmomanometer during a 3-min orthostatic blood pressure assessment. The reproducibility of orthostatic haemodynamic responses has been inconsistent across studies [2]. Orthostatic blood pressure responses measured with sphygmomanometer may not be reproducible in patients with documented symptomatic

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