Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees

Abstract

Purpose: Sarcopenia and delayed orthostatic blood pressure (BP) recovery are two disorders increasingly associated with adverse clinical outcomes in older adults. There may exist a pathophysiological link between the two via the skeletal muscle pump of the lower limbs. Previously in a large population-based study, we found an association between probable sarcopenia and orthostatic BP recovery. Here, we sought to determine the association between confirmed sarcopenia and orthostatic BP recovery in falls clinic attendees aged 50 years or over.

Methods: One hundred and nine recruited patients (mean age 70 years, 58% women) underwent an active stand with non-invasive beat-to-beat haemodynamic monitoring. Hand grip strength and five-chair stands time were measured, and bioelectrical impedance analysis was performed. They were then classified as robust, probable sarcopenic or sarcopenic as per the European Working Group on Sarcopenia in Older People guidelines. Mixed effects models with linear splines were used to model the effect of sarcopenia status on orthostatic BP recovery, whilst controlling for potential confounders.

Results: Probable sarcopenia was identified in 32% of the sample and sarcopenia in 15%. Both probable and confirmed sarcopenia were independently associated with an attenuated rate of recovery of both systolic and diastolic BP in the 10-20 s period after standing. Attenuation was larger for confirmed than probable sarcopenia (systolic BP β - 0.85 and - 0.59, respectively, P < 0.01; diastolic BP β - 0.65, - 0.45, P < 0.001).

Conclusion: Sarcopenia was independently associated with slower BP recovery during the early post-stand period. The potentially modifiable effect of the skeletal muscle pump in orthostatic haemodynamics requires further study.

Keywords: Blood pressure recovery; Older people; Orthostasis; Orthostatic hypotension; Sarcopenia; Skeletal muscle pump.

Fig. 1

Mean change in systolic blood pressure, diastolic blood pressure (mmHg) and heart rate (beats per minute—bpm) after standing grouped by sarcopenia status. Unadjusted. Error bars: standard error of the mean

Fig. 2

Predicted means and standard error of the mean from mixed-effects models for change in systolic and diastolic blood pressure (mmHg) after standing, grouped by sarcopenia status. Models were adjusted for age, sex, diabetes, hypertension, cardiovascular and psychotropic medications and heart rate