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Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study: Findings From The Irish Longitudinal Study on Ageing (TILDA)
Open accessAbstract
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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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]
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2018 ESC Guidelines for the diagnosis and management of syncope
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Metadata
- 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 › Cardiology and Cardiovascular Medicine › 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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