Uncontrolled hypertension and orthostatic hypotension in relation to standing balance in elderly hypertensive patients

Figures & data

Figure 1 The procedure of patient selection.

Table 1 Comparison of clinical data between the non-OH group and OH group (n=176)

Characteristics	All patients (n=176)	Non-OH group (n=140)	OH group (n=36)	P-value
Socio-demographic characteristics
Age (years), mean ± SDb	76.7±6.6	75.9±6.6	79.6±5.8	0.003
Men, n (%)	101 (57.4)	81 (57.9)	20 (55.6)	0.803
Divorced or widowed, n (%)	44 (25.0)	38 (27.1)	6 (16.7)	0.195
Current or former smokers, n (%)a	16 (9.1)	14 (10.0)	2 (5.6)	0.324
Current or former drinkers, n (%)a	15 (8.5)	14 (10.0)	1 (2.8)	0.145
Living alone, n (%)	115 (71.4)	96 (72.2)	19 (67.9)	0.645
BMI (kg/m^2), mean ± SDb	24.0±3.1	23.9±3.0	24.2±3.5	0.684
Medical characteristics
Concomitant medical conditions, n (%)
Cardiovascular disease	85 (48.3)	71 (50.7)	14 (38.9)	0.205
Cerebrovascular disease	40 (22.7)	27 (19.3)	13 (36.1)	0.032
Diabetes mellitus	35 (19.9)	28 (20.0)	7 (19.4)	0.941
Renal diseasea	22 (12.5)	19 (13.6)	3 (8.3)	0.574
Musculoskeletal disease	47 (26.9)	40 (28.6)	7 (20.0)	0.306
Comorbidities (≥5 diseases), n (%)	80 (45.5)	64 (45.7)	16 (44.4)	0.891
Polypharmacy (≥5 drugs), n (%)	77 (43.8)	59 (42.1)	18 (50.0)	0.397
GDS (≥6 score), n (%)	24 (13.7)	18 (12.9)	6 (17.1)	0.583
MMSE, median (IQR)c	27 (24–28)	27 (24–28)	27 (24–28)	0.926
Gait disorder, n (%)	70 (39.8)	51 (36.4)	19 (52.8)	0.074
Fall incidents in previous 12 months, n (%)	45 (25.6)	33 (23.6)	12 (33.3)	0.231
Walking aids, n (%)	21 (11.9)	14 (10.0)	7 (19.4)	0.119
Fear of falling, n (%)	64 (36.4)	51 (36.4)	13 (36.1)	0.972
Grip strength (kg), mean ± SDb	29.5±9.7	29.9±9.9	27.9±9.0	0.267
Four-meter walk (seconds), median (IQR)c	6.5 (5.3–9.1)	6.5 (5.3–9.2)	6.0 (5.1–7.2)	0.244
Laboratory data
Calcium (mg/dL), mean ± SDb	2.3±0.1	2.3±0.1	2.2±0.1	0.367
25-OH D (ng/mL), mean ± SDb	18.3±9.0	18.4±9.0	18.0±9.1	0.844

Notes: All data were analyzed by the chi-square test unless marked.

a Fisher’s exact test;

b the unpaired t-test;

c the Mann–Whitney U-test.

Abbreviations: OH, orthostatic hypotension; SD, standard deviation; BMI, body mass index; GDS, geriatric depression scale; MMSE, mini-mental state examination; IQR, interquartile range; 25-OH D, 25-hydroxyvitamin D.

Table 2 Hypertension correlated characteristics of the non-OH and OH groups (n=176)

Characteristics	All patients (n=176)	Non-OH group (n=140)	OH group (n=36)	P-value
Hypertension duration, n (%)				0.984
Unknown	77 (43.8)	61 (43.6)	16 (44.4)
≤10 years	51 (29.0)	41 (29.3)	10 (27.8)
>10 years	48 (27.3)	38 (27.1)	10 (27.8)
Hypertension stage, n (%)				0.919
Unknown	59 (33.5)	46 (32.9)	13 (36.1)
Stage 1	16 (9.1)	12 (8.6)	4 (11.1)
Stage 2	50 (28.4)	41 (29.3)	9 (25.0)
Stage 3	51 (29.0)	41 (29.3)	10 (27.8)
Antihypertensive medications, n (%)
Calcium channel blockers	100 (56.8)	78 (55.7)	22 (61.1)	0.560
AT receptor blockers/ACE inhibitors	90 (51.1)	73 (52.1)	17 (47.2)	0.598
Diuretics	36 (20.5)	28 (20.0)	8 (22.2)	0.768
Beta blockers	35 (20.0)	30 (21.6)	5 (14.3)	0.336
Uncontrolled hypertension, n (%)	62 (35.2)	39 (27.9)	23 (63.9)	<0.001
Blood pressure from supine to stand position (mmHg), mean ± SD
SBPb
Supine	140±17	138±16	148±18	0.001
Immediate	133±21	133±20	132±24	0.826
1 minute	138±17	139±16	135±20	0.341
3 minutes	137±18	138±17	129±21	0.008
DBPb
Supine	72±10	72±10	75±11	0.065
Immediate	72±11	73±11	69±9	0.036
1 minute	74±11	74±10	71±11	0.207
3 minutes	73±11	74±11	66±9	<0.001

Notes: All data were analyzed by the chi-square test unless marked.

b The unpaired t-test.

Abbreviations: OH, orthostatic hypotension; AT, angiotensin; ACE, angiotensin-converting enzyme; SD, standard deviation; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 2 Comparison of standing balance between non-OH group and OH group.

Notes: (A) B-POMA score: the Mann–Whitney U-test, P<0.05; (B) side-by-side stance: Fisher’s exact test, P<0.01; the chi-square test, P>0.05, respectively; (C) the tandem test: the chi-square test, P<0.01. All significance tests were adjusted for age.
Abbreviations: B-POMA, the balance subscale of the Tinetti performance-oriented mobility assessment; OH, orthostatic hypotension.

Table 3 Association between blood pressure decrease and B-POMA score in all elderly patients with hypertension (n=176)

	SBP decrease (mmHg)a			DBP decrease (mmHg)b
	Immediate	1 minute	3 minutes	Immediate	1 minute	3 minutes
B-POMA score	−0.034	−0.047	−0.180c	−0.142	−0.185c	−0.237d

Notes: All data were analyzed by partial correlations after adjustment for age, sex, and concomitant cerebrovascular disease.

a Supine SBP minus SBP after postural change;

b supine DBP minus DBP after postural change;

c P<0.05;

d P<0.01.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; B-POMA, the balance subscale of the Tinetti performance-oriented mobility assessment.

Table 4 Association between blood pressure decrease and impaired standing balance in all elderly patients with hypertension (n=176)

	Side-by-side stance				Tandem stance
	Impaired immediate standing balance		Impaired prolonged standing balance		Impaired immediate standing balance
	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Supine blood pressurea
SBP	1.03 (1.00–1.05)	0.086	0.99 (0.97–1.01)	0.460	1.00 (0.98–1.03)	0.676
DBP	1.01 (0.96–1.07)	0.621	1.00 (0.97–1.04)	0.871	0.98 (0.95–1.02)	0.267
Blood pressure decrease after postural change
SBP decreaseb
Immediate	1.21 (0.36–4.00)	0.760	1.06 (0.45–2.50)	0.898	0.99 (0.41–2.40)	0.988
1 minute	0.98 (0.18–5.36)	0.977	0.42 (0.11–1.61)	0.205	1.47 (0.43–5.05)	0.542
3 minutes	3.91 (1.27–12.03)	0.017	1.54 (0.56–4.20)	0.403	1.93 (0.72–5.16)	0.188
DBP decreasec
Immediate	2.25 (0.70–7.22)	0.172	0.86 (0.33–2.24)	0.759	2.61 (1.01–6.73)	0.047
1 minute	2.49 (0.74–8.43)	0.143	0.94 (0.33–2.67)	0.910	3.85 (1.33–11.14)	0.013
3 minutes	3.26 (1.02–10.43)	0.047	2.32 (0.82–6.58)	0.113	3.41 (1.25–9.32)	0.017
OHd	3.44 (1.26–9.33)	0.016	1.73 (0.76–3.92)	0.191	2.96 (1.31–6.68)	0.009
Uncontrolled hypertensione	3.14 (1.14–8.64)	0.027	0.93 (0.46–1.91)	0.852	1.82 (0.88–3.76)	0.108

Notes: All data were from logistic regression analysis with adjustment for age, sex, and concomitant cerebrovascular disease. The ability of standing balance: 0= stable, 1= impaired;

a measured after at least 5 minutes in the supine position;

b supine SBP minus SBP after postural change ≥20 mmHg;

c supine DBP minus DBP after postural change ≥10 mmHg;

d a decline of at least 20 mmHg in SBP and/or at least 10 mmHg in DBP within 3 minutes of standing position;

e blood pressure of ≥140/90 mmHg if accompanied with diabetes mellitus (DM) or chronic kidney disease (CKD), or ≥150/90 mmHg if no DM and no CKD.

Abbreviations: OR, odds ratio; CI, confidence interval; SBP, systolic blood pressure; DBP, diastolic blood pressure; OH, orthostatic hypotension.