Associations of blood pressure with risk of injurious falls in old age vary by functional status: A cohort study

Impaired Balance Predicts Cardiovascular Disease in 70-Year-Old Individuals-An Observational Study From the Healthy Aging Initiative

BACKGROUND

Limited research has explored balance problems as a prospective risk factor for cardiovascular disease (CVD). This study aimed to characterize the association between balance measures and the risk of incident CVD in a population of 70-year-olds.

METHODS AND RESULTS

From 2012 to 2022 a cohort of 4927 older individuals who were CVD free underwent balance assessments using a balance board. Measurements included lateral and anterior-posterior sway, along with a safety limit of stability in a subcohort (N=2782). Time to first hospitalization for CVD, encompassing stroke, myocardial infarction, or angina pectoris was the primary outcome. Multivariable regression models assessed associations between balance parameters and CVD risk. Over a mean follow-up of 4.9 years, 320 individuals were hospitalized for CVD. In a balance test with eyes open, increased lateral sway at baseline was associated with a higher risk of CVD (hazard ratio [HR], 1.014 [95% CI, 1.004-1.025], P=0.005, per mm increased sway), after adjustment for traditional risk factors for CVD. Similarly, individuals with CVD during follow-up exhibited higher lateral sway with eyes closed at baseline (HR, 1.015 [95% CI, 1.005-1.025], P=0.002, per mm increased sway), after multivariable adjustment. The 4 strongest independent predictors of CVD included lateral sway and were associated with a population attributable fraction of 61% (95% CI, 54-68).

CONCLUSIONS

In community-dwelling 70-year-olds, impaired lateral balance was an independent predictor of later CVD, after adjustment for traditional risk factors. This may suggest that position balance could be used as an early risk marker for underlying atherosclerotic disease.

The impact of cardiovascular diagnostics and treatments on fall risk in older adults: a scoping review and evidence map

BACKGROUND

We aimed to summarize the published evidence on the fall risk reducing potential of cardiovascular diagnostics and treatments in older adults.

METHODS

Design: scoping review and evidence map.

DATA SOURCES

Medline and Embase.

ELIGIBILITY CRITERIA

all available published evidence; Key search concepts: "older adults," "cardiovascular evaluation," "cardiovascular intervention," and "falls." Studies reporting on fall risk reducing effect of the diagnostic/treatment were included in the evidence map. Studies that investigated cardiovascular diagnostics or treatments within the context of falls, but without reporting a fall-related outcome, were included in the scoping review for qualitative synthesis.

RESULTS

Two articles on cardiovascular diagnostics and eight articles on cardiovascular treatments were included in the evidence map. Six out of ten studies concerned pacemaker intervention of which one meta-analyses that included randomized controlled trials with contradictory results. A combined cardiovascular assessment/evaluation (one study) and pharmacotherapy in orthostatic hypotension (one study) showed fall reducing potential. The scoping review contained 40 articles on cardiovascular diagnostics and one on cardiovascular treatments. It provides an extensive overview of several diagnostics (e.g., orthostatic blood pressure measurements, heart rhythm assessment) useful in fall prevention. Also, diagnostics were identified, that could potentially provide added value in fall prevention (e.g., blood pressure variability and head turning).

CONCLUSION

Although the majority of studies showed a reduction in falls after the intervention, the total amount of evidence regarding the effect of cardiovascular diagnostics/treatments on falls is small. Our findings can be used to optimize fall prevention strategies and develop an evidence-based fall prevention care pathway. Adhering to the World guidelines on fall prevention recommendations, it is crucial to undertake a standardized assessment of cardiovascular risk factors, followed by supplementary testing and corresponding interventions, as effective components of fall prevention strategies. In addition, accompanying diagnostics such as blood pressure variability and head turning can be of added value.

Association of low blood pressure and falls: An analysis of data from the Leiden 85-plus Study

BACKGROUND

Falls and consequent injuries are prevalent in older adults. In this group, half of injury-related hospitalizations are associated with falls and the rate of falls increases with age. The evidence on the role of blood pressure and the use of antihypertensive treatment on the risk of falls remains unclear in oldest-old adults (≥85 years).

OBJECTIVES

To examine the association between systolic blood pressure (SBP) and incident falls with medical consequences in oldest-old adults and to analyse whether this association is modified by the use of antihypertensive treatments or the presence of cardiovascular disease.

METHODS

We analysed data from the Leiden 85-plus Study, a prospective, population-based cohort study with adults aged ≥85 years and a 5-year follow-up. Falls with medical consequences were reported by the treating physician of participants. We assessed the association between time-updated systolic blood pressure and the risk of falling over a follow-up period of five years using generalized linear mixed effects models with a binomial distribution and a logit link function. Subgroup analyses were performed to examine the role of antihypertensive treatment and the difference between participant with and without cardiovascular disease.

RESULTS

We analysed data from 544 oldest-old adults, 242 (44.4%) of which used antihypertensives. In 81 individuals (15%) ≥1 fall(s) were reported during the follow-up period. The odds for a fall decreased by a factor of 0.86 (95% CI 0.80 to 0.93) for each increase in blood pressure by 10 mmHg. This effect was specific to blood pressure values above 130mmHg. We did not find any evidence that the effect would be modified by antihypertensive treatment, but that there was a tendency that it would be weaker in participants with cardiovascular disease (OR 0.81, 95% CI 0.72 to 0.90 per 10mmHg) compared to those without cardiovascular disease (OR 0.94, 95% CI 0.84 to 1.05 per 10mmHg).

CONCLUSION

Our results point towards a possible benefit of higher blood pressure in the oldest-old with respect to falls independent of the use of antihypertensive treatments.

The Associations of Pulse Pressure and Mean Arterial Pressure on Physical Function in Older Americans

Background: We sought to examine the associations of pulse pressure (PP) and mean arterial pressure (MAP) on physical function in older Americans. Methods: Our analytic sample included 10,478 adults aged ≥65 years from the 2006–2016 Health and Retirement Study. Handgrip strength, gait speed, and standing balance were collected using relatively standard protocols. PP and MAP were calculated from blood pressure measurements. Results: Older Americans with any abnormality in PP had 1.15 (95% confidence interval (CI): 1.05–1.25) greater odds for slowness and 1.14 (CI: 1.05–1.24) greater odds for poorer standing balance. Persons with any abnormality in MAP had 0.90 (CI: 0.82–0.98) decreased odds for weakness and 1.10 (CI: 1.01–1.20) greater odds for poorer standing balance. Those with low PP had 1.19 (CI: 1.03–1.36) greater odds for slow gait speed, while persons with low MAP had 1.50 (CI: 1.09–2.05) greater odds for weakness and 1.45 (CI: 1.03–2.04) greater odds for slowness. Older Americans with high PP had 1.13 (CI: 1.03–1.25) greater odds for slowness and 1.21 (CI: 1.10–1.32) greater odds for poorer balance, whereas those with high MAP had 0.87 (CI: 0.80–0.95) decreased odds for weakness. Conclusions: Cardiovascular dysfunction, as observed by PP and MAP, may help to explain some of our findings.

Geriatric syndrome of falls in comorbid patients: paradox of normotension in the elderly

Background. Falls as geriatric syndrome in elderly age are associated with high health risks, including serious injury, prolonged hospital stays, and medical and follow-up costs. The prevalence of falls in comorbid elderly patients without hypertension remains uncertain. Aim. To study the incidence of falls in the comorbid elderly with or without hypertension. Materials and methods. The study included 5240 outpatients aged 60 and over with three or more chronic diseases treated at Moscow polyclinics with verified diagnoses according to medical records in 20152018. The exclusion criteria were acute illness, exacerbation of chronic diseases, disease decompensation, severe sensory impairment and dementia. Student's t-criterion was used to compare quantitative variables between groups and Fisher's exact test was used to compare binary variables. Results. The age of study participants was 71.0 0.1 years, 72.4% women. The vast majority of patients (99.3%, n=5202) has been diagnosed with arterial hypertension or essential hypertension, and 0.7% of patients (n=38) had no such diagnoses. The incidence of falls in hypertensive patients was 16.4% (n=857), while 42.1% (n=16) of patients without hypertension reported falls (p=0.00018; odds ratio 3.69; 95% confidence interval 1.807.38). Conclusion. The paradox of the greater frequency of falls in the group of elderly patients who experienced no blood pressure elevation episodes compared with hypertensive patients has not been fully understood yet and can indicate that the risk of falls in patients who experienced no blood pressure elevation is higher; however, further research is required.