Orthostatic hypotension and night-time dipper patterns in geriatric outpatients

Abstract

Orthostatic hypotension (OH) and blood pressure circadian dysfunctions are common in older adults and may be related to aging-related autonomic nervous system deficits. This study aimed to evaluate the relationship between orthostatic and nocturnal blood pressure changes in geriatric outpatients. This cross-sectional study was carried out with 425 Italian individuals aged ≥65 years (mean age 75.8 ± 7.1 years) who attended a hypertension outpatient clinic from January 2013 to January 2020. Each patient underwent orthostatic testing and noninvasive 24-h blood pressure monitoring (ABPM). OH was detected in 38.1% of patients, and these individuals were more likely to have abnormal circadian blood pressure patterns (reverse and nondipper) than those without OH (61.7% vs. 51.7%; p = 0.045). In linear regression, after adjusting for potential confounders, orthostatic and nocturnal changes in systolic blood pressure were inversely associated (β = -0.63, 95% CI [-0.95; -0.32]; p < 0.001). This association was stronger in patients ≥80 years. OH is highly prevalent in older patients and is associated with altered nocturnal blood pressure profiles, especially in the oldest old. Because both OH and altered blood pressure patterns are associated with elevated cardiovascular risk and mortality, our study suggests that elderly patients with OH should undergo noninvasive 24-h blood pressure monitoring.

Keywords: Aged; Ambulatory blood pressure monitoring; Orthostatic hypotension; Prevalence.