LB02.09

Abstract

Objective: Postural hypotension (PH) is a risk factor for falls, and associated with excess mortality. Recommendations on testing for PH vary: NICE (2011) advises checking in the presence of falls or symptoms whilst ESH/ESC (2013) advises checking in elderly and diabetics. It is recommended that blood pressure (BP) is measured both 1 and 3 minutes after standing; this is seldom done in clinical practice. We studied the InChianti dataset to identify associations of PH that could inform clinical practice. Design and method: The InCHIANTI study is a population-based study established to understand causes of walking difficulties in older persons. Subjects were randomly selected from population registries in the Chianti area of Italy in 1998; they underwent extensive baseline interviews and examinations, and are being followed up triennially. BP at recruitment was measured supine and after one and three minutes standing with a mercury sphygmomanometer. Systolic PH was defined as a >=20mmHg fall in supine BP on standing. Survival with or without PH was analysed and Cox proportional hazard ratios (HRs) calculated. Univariable cross sectional associations for PH were analysed using χ2 tests. Potentially significant associations (P<0.1) were included in multivariable linear regression models. Significant multivariable associations were used to derive a simple prediction score (DROP score). Results: At recruitment 101/1352 (7.5%) and 89/1352 (6.6%) participants had PH after 1 and 3 minutes standing respectively. PH was associated with increased all-cause mortality over 10 years (HR 2.0 (95%CI 1.5 to 2.7) for both 1 and 3 minutes). On multivariable regression PH was associated with age >=65 years, any fall in the previous year, and previous diagnoses of hypertension, stroke or angina. A simple scoring system of 0 to 5 according to the presence of each of these variables suggested numbers needed to screen of 11 for a score of 2 and 8 for a score of 3 (figure). Conclusions: The likelihood of PH can be predicted from existing medical history. Presence of diabetes is not a predictor of PH in this cohort. Further work is underway to refine and validate the DROP score.