Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study: Findings From The Irish Longitudinal Study on Ageing (TILDA)
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BACKGROUND: In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample. METHODS AND RESULTS: Participants were recruited from a nationally representative cohort study (≥50 years). Beat-to-beat systolic BP, diastolic BP, and heart rate records were analyzed among those who underwent an active stand test (n=4475). Normograms were estimated by use of generalized additive models for location, shape, and scale with Box-Cox power exponential distribution. Prevalence estimates of impaired BP stabilization, initial orthostatic hypotension, and orthostatic hypotension are reported. Orthostatic BP responses in adults aged 50 to 59 years stabilized within 30 seconds of standing, with older groups taking 30 seconds or longer. The total prevalence of impaired BP stabilization was 15.6% (95% confidence interval [CI], 14.1%-17.1%), increasing with age to 41.2% (95% CI, 30.0%-52.4%) in people ≥80 years old. Initial orthostatic hypotension occurred in 32.9% (95% CI, 31.2%-34.6%) of the population aged ≥50 years, with no age gradient evident. The prevalence of orthostatic hypotension was 6.9% (95% CI, 5.9%-7.8%) in the total population, increasing to 18.5% (95% CI, 9.0%-28.0%) in those aged ≥80 years old. CONCLUSIONS: Significant age-related differences exist in the time course of postural BP responses, with abnormal responses taking longer than 30 seconds to stabilize. Impaired BP stabilization is more common as we age, affecting more than two-fifths of the population aged ≥80 years, and may play a future role in the management of falls and syncope.
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Orthostatic hypotension is often associated with hypertension, dementia, other neurodegenerative diseases, atrial fibrillation, diabetes and heart failure.
“Orthostatic hypotension is a common finding in elderly patients because of their impaired baroreceptor sensitivity [237], and is often associated with hypertension, dementia, other neurodegenerative diseases (e.g. Parkinson's disease), atrial fibrillation, diabetes and heart failure [238–241].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [239]
The paper’s introductory passage (indexed under Abstract; page unavailable) says orthostatic hypotension occurs in diabetes mellitus and brain aging, and it discusses supine hypertension. It does not establish the full claimed list of associations: dementia, other neurodegenerative diseases, atrial fibrillation, and heart failure are not supported by the passages found. Recording heart failure and irregular heart rhythm as participant characteristics does not establish an association with orthostatic hypotension. (LLM, conf=0.84)
Experimental — accuracy not yet measuredFailure of systolic blood pressure to stabilize is a risk factor for subsequent falls and syncope.
“Such failure of systolic BP to stabilize is a risk factor for subsequent falls and syncope.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [398]
The Discussion says impaired BP control may lead to syncope and falls, supporting the proposed risk relationship. But the paper presents this as a possibility, not an established risk factor, and the cited passages do not report subsequent falls or syncope after BP measurement. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFailure of orthostatic blood pressure to stabilize is present in up to 40% of community-dwelling people over 80 years of age when blood pressure is measured using phasic blood pressure technology.
“Failure of orthostatic BP to stabilize is present in up to 40% of community-dwelling people >80 years of age when BP is measured using phasic BP technology. 398”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [398]
Orthostatic hypotension is poorly reproducible; thus assessments carried out at doctors' office are likely to underestimate its true prevalence.
“However, orthostatic hypotension is poorly reproducible; thus assessments carried out at the doctors’ office are likely to underestimate its true prevalence [235].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [235]
The Discussion (page unavailable) says prevalence estimates depend on measurement methods and on whether a sustained blood-pressure drop is required. It does not say orthostatic hypotension is poorly reproducible or that doctors’ office assessments underestimate its true prevalence; searches for repeatability and office measurements found no such passage. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Finucane, C., O’Connell, M. D. L., Fan, C. W., Savva, G. M., Soraghan, C. J., Nolan, H., Cronin, H., & Kenny, R. A.
- Affiliations
- University of East Anglia (GB)
- Venue
- Circulation
- Published
- 2014-11-11
- Volume
- 130
- Issue
- 20
- Pages
- 1780-1789
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2076099824
- Cited by
- 219
- References
- 42
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 19 · 2023: 12 · 2022: 17 · 2021: 23 · 2020: 21 · 2019: 31 · 2018: 22 · 2017: 20 · 2016: 16 · 2015: 14 · 2014: 2
- FWCI
- 17.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- orthostatic hypotension, age-related changes, normative reference data, beat-to-beat blood pressure, postural blood pressure response, heart rate, older adults, prevalence, falls, syncope
- MeSH terms
- Aged, Aged, 80 and over, Aging, Blood Pressure, Diastole, Female, Follow-Up Studies, Heart Rate, Humans, Hypotension, Orthostatic, Ireland, Longitudinal Studies, Male, Middle Aged, Posture, Reference Values, Systole, Time Factors, Prevalence
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