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Review
. 2017 Jul 1;46(4):568-575.
doi: 10.1093/ageing/afx024.

Is orthostatic hypotension related to falling? A meta-analysis of individual patient data of prospective observational studies

Laura Caroline Hartog  1 , Dennis Schrijnders  1   2 , G W D Landman  2   3 , Klaas Groenier  1   4 , Nanne Kleefstra  2   5 , Henk J G Bilo  1   6   7 , Kornelis Johannes Jongers van Hateren  8
Affiliations
Review

Is orthostatic hypotension related to falling? A meta-analysis of individual patient data of prospective observational studies

Laura Caroline Hartog et al. Age Ageing. .

Abstract

Background: orthostatic hypotension (OH) is one out of many risk factors believed to contribute to an increased fall risk in elderly subjects but it is unclear whether an independent association between OH and falling exists.

Objectives: to perform an individual patient data (IPD) meta-analysis of prospective observational studies investigating the relationship between OH and falling.

Design: MEDLINE, EMBASE, the Cochrane Library and the abstracts of annual meetings of selected hypertension societies were searched. Both one-stage (analysing all IPD from all studies simultaneously) and two-stage (analysing IPD per study, and then pooling the results) methods were used, and both logistic and cox regression analyses were performed. The study protocol was published on PROSPERO (2015:CRD42015019178).

Results: from 34 selected abstracts, 6 studies were included. IPD were provided in 1,022 patients from 3 cohorts and were included in the IPD meta-analysis. The one-stage meta-analysis showed a significant relationship between OH and time to first fall incident (hazard ratio (HR) 1.52 (95% Confidence Interval (CI) 1.23-1.88)). No significant relationship between OH and falling was found in the one-stage logistic regression analysis and the two-stage logistic and cox regression analyses.

Conclusions: this IPD meta-analysis of prospective observational studies showed a clear and significant relationship between OH and time to first fall incident. Although the ORs of falling was not significantly different for patients with and without OH, a the cox regression analyses reporting HRs and including time to incident provided more clinically relevant information in present meta-analysis.

Keywords: Orthostatic hypotension; fall-risk; individual patient data; meta-analysis, older people.

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Figures

Figure 1.
Figure 1.
Flowchart.
Figure 2.
Figure 2.
Forrest Plot of the adjusted ORs and HRs for the effect of OH on the risk of falling with IPD for each study (two-stage method). Adjusted for age, gender, BMI, DM, antihypertensive medication, number of medication and mean SBP.
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References

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