Frailty and the risk of orthostatic hypotension: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

NIU Fang ¹ , CHEN Fei ² , MEI Fan ² , GAO Qianqian ² , ZHAO Li ² , ZHAO Bing ³ , HU Kaiyan ² ,  MA Bin ^2,3,4

1. Lanzhou University Second Hospital, Lanzhou 730000, P.R.China;
2. Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou 730000, P.R.China;
3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P.R.China;
4. Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, School of Basic Medical Science of Lanzhou University, Lanzhou 730000, P.R.China;

Corresponding?author：

MA Bin, Email: kittymb2017@163.com

Keywords：

Frailty; Frailty syndrome; Orthostatic hypotension; Orthostatic blood pressure; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202008097

Video：

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Objective To systematically review the relationship between frailty and risk of orthostatic hypotension.Methods PubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the association between frailty and orthostatic hypotension from inception to July 7^th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.Results Five cross-sectional studies involving 8 671 patients were included. The results of meta-analysis showed that prefrailty (OR=1.04, 95%CI 0.99 to 1.09, P=0.11) and frailty (OR=1.02, 95%CI=0.92 to 1.13, P=0.70) were not associated with orthostatic hypotension. The results of subgroup analysis showed that differences of sample size (<500 or ≥500), using different frailty assessment tools (Fried scale, clinical frailty scale, and frailty index), different regions (Europe, Asia, and America) and different sources of studied subjects (hospitals and communities), the risk of orthostatic hypotension were not increased with frailty.Conclusions Current evidence shows that frailty does not increase the risk of orthostatic hypotension. Due to limited quality and quantity of included studies, the above conclusions are needed to be validated by more high-quality studies.

Citation： NIU Fang, CHEN Fei, MEI Fan, GAO Qianqian, ZHAO Li, ZHAO Bing, HU Kaiyan, MA Bin. Frailty and the risk of orthostatic hypotension: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(2): 153-159. doi: 10.7507/1672-2531.202008097 Copy

1.	Joseph A, Wanono R, Flamant M, et al. Orthostatic hypotension: a review. Nephrol Ther, 2017, 13(Suppl 1): S55-S67.
2.	Feldstein C, Weder AB. Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens, 2012, 6(1): 27-39.
3.	Low PA. Prevalence of orthostatic hypotension. Clin Auton Res, 2008, 18(Suppl 1): 8-13.
4.	Hiitola P, Enlund H, Kettunen R, et al. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens, 2009, 23(1): 33-39.
5.	Townsend RR, Chang TI, Cohen DL, et al. Orthostatic changes in systolic blood pressure among SPRINT participants at baseline. J Am Soc Hypertens, 2016, 10(11): 847-856.
6.	Finucane C, O’Connell MD, Fan CW, et al. Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA). Circulation, 2014, 130(20): 1780-1789.
7.	O'Connell MD, Savva GM, Fan CW, et al. Orthostatic hypotension, orthostatic intolerance and frailty: the Irish Longitudinal Study on Aging-TILDA. Arch Gerontol Geriatr, 2015, 60(3): 507-513.
8.	Clark CE, Thomas D, Warren FC, et al. Detecting risk of postural hypotension (DROP): derivation and validation of a prediction score for primary care. BMJ Open, 2018, 8(4): e020740.
9.	Liguori I, Russo G, Coscia V, et al. Orthostatic hypotension in the elderly: a marker of clinical frailty? J Am Med Dir Assoc, 2018, 19(9): 779-785.
10.	Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: epidemiology, prognosis, and treatment. J Am Coll Cardiol, 2015, 66(7): 848-860.
11.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
12.	Rockwood MR, Howlett SE, Rockwood K. Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty. Arch Gerontol Geriatr, 2012, 54(3): e255-260.
13.	Romero-Ortuno R, Cogan L, O'Shea D, et al. Orthostatic haemodynamics may be impaired in frailty. Age Ageing, 2011, 40(5): 576-583.
14.	王小菊, 藺建宇, 孫倩美, 等. 住院老年衰弱病人直立性低血壓, 跌倒發生情況分析. 護理研究, 2018, 32(18): 2971-2973.
15.	Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology, 1996, 46(5): 1470.
16.	Frith J. Diagnosing orthostatic hypotension: a narrative review of the evidence. Br Med Bull, 2015, 115(1): 123-134.
17.	Pasma JH, Bijlsma AY, Klip JM, et al. Blood pressure associates with standing balance in elderly outpatients. PLoS One, 2014, 9(9): e106808.
18.	Bergman H, Ferrucci L, Guralnik J, et al. Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci, 2007, 62(7): 731-737.
19.	Rockwood K, Abeysundera MJ, Mitnitski A. How should we grade frailty in nursing home patients? J Am Med Dir Assoc, 2007, 8(9): 595-603.
20.	Pujos-Guillot E, Pétéra M, Jacquemin J, et al. Identification of pre-frailty sub-phenotypes in elderly using metabolomics. Front Physiol, 2019, 9: 1903.
21.	曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
22.	熊風, 賴玉清, 涂嘉欣, 等. 中國老年人群睡眠障礙流行特征的Meta分析. 中國循證醫學雜志, 2019, 19(4): 28-33.
23.	Chen L, Xu Y, Chen XJ, et al. Association between orthostatic hypotension and frailty in hospitalized older patients: a geriatric syndrome more than a cardiovascular condition. J Nutr Health Aging, 2019, 23(4): 318-322.
24.	Kocyigit SE, Soysal P, Bulut EA, et al. What is the relationship between frailty and orthostatic hypotension in older adults? J Geriatr Cardiol, 2019, 16(3): 272-279.
25.	Wieling W, Schatz IJ. The consensus statement on the definition of orthostatic hypotension: a revisit after 13 years. J Hypertens, 2009, 27(5): 935-938.
26.	Benvenuto LJ, Krakoff LR. Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens, 2011, 24(2): 135-144.
27.	McDonagh J, Martin L, Ferguson C, et al. Frailty assessment instruments in heart failure: a systematic review. Eur J Cardiovasc Nurs, 2018, 17(1): 23-35.
28.	Sze S, Pellicori P, Zhang J, et al. Identification of frailty in chronic heart failure. JACC Heart Fail, 2019, 7(4): 291-302.
29.	Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med, 2011, 27(1): 1-15.
30.	Sleight C, Holtzer R. Differential associations of functional and cognitive health outcomes with pre-frailty and frailty states in community-dwelling older adults. J Health Psychol, 2020, 25(8): 1057-1063.
31.	司華新, 金雅茹, 喬曉霞, 等. 中文版Tilburg衰弱量表在養老機構老年人中的信效度檢驗. 中國老年學雜志, 2018, 38(16): 4046-4049.
32.	Kojima G, Taniguchi Y, Iliffe S, et al. Transitions between frailty states among community-dwelling older people: a systematic review and meta-analysis. Ageing Res Rev, 2019, 50: 81-88.
33.	Ostir GV, Ottenbacher KJ, Markides KS. Onset of frailty in older adults and the protective role of positive affect. Psychol Aging, 2004, 19(3): 402-408.
34.	Lanziotti Azevedo da Silva S, Campos Cavalcanti Maciel á, de Sousa Máximo Pereira L, et al. Transition patterns of frailty syndrome in comunity-dwelling elderly individuals: a longitudinal study. J Frailty Aging, 2015, 4(2): 50-55.
35.	Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet, 2013, 381(9868): 752-762.
36.	Inouye SK, Studenski S, Tinetti ME, et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc, 2007, 55(5): 780-791.
37.	Swift CG, Iliffe S. Assessment and prevention of falls in older people--concise guidance. Clin Med (Lond), 2014, 14(6): 658-662.
38.	ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens, 2013, 31(10): 1925-1938.

1. Joseph A, Wanono R, Flamant M, et al. Orthostatic hypotension: a review. Nephrol Ther, 2017, 13(Suppl 1): S55-S67.
2. Feldstein C, Weder AB. Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens, 2012, 6(1): 27-39.
3. Low PA. Prevalence of orthostatic hypotension. Clin Auton Res, 2008, 18(Suppl 1): 8-13.
4. Hiitola P, Enlund H, Kettunen R, et al. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens, 2009, 23(1): 33-39.
5. Townsend RR, Chang TI, Cohen DL, et al. Orthostatic changes in systolic blood pressure among SPRINT participants at baseline. J Am Soc Hypertens, 2016, 10(11): 847-856.
6. Finucane C, O’Connell MD, Fan CW, et al. Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA). Circulation, 2014, 130(20): 1780-1789.
7. O'Connell MD, Savva GM, Fan CW, et al. Orthostatic hypotension, orthostatic intolerance and frailty: the Irish Longitudinal Study on Aging-TILDA. Arch Gerontol Geriatr, 2015, 60(3): 507-513.
8. Clark CE, Thomas D, Warren FC, et al. Detecting risk of postural hypotension (DROP): derivation and validation of a prediction score for primary care. BMJ Open, 2018, 8(4): e020740.
9. Liguori I, Russo G, Coscia V, et al. Orthostatic hypotension in the elderly: a marker of clinical frailty? J Am Med Dir Assoc, 2018, 19(9): 779-785.
10. Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: epidemiology, prognosis, and treatment. J Am Coll Cardiol, 2015, 66(7): 848-860.
11. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
12. Rockwood MR, Howlett SE, Rockwood K. Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty. Arch Gerontol Geriatr, 2012, 54(3): e255-260.
13. Romero-Ortuno R, Cogan L, O'Shea D, et al. Orthostatic haemodynamics may be impaired in frailty. Age Ageing, 2011, 40(5): 576-583.
14. 王小菊, 藺建宇, 孫倩美, 等. 住院老年衰弱病人直立性低血壓, 跌倒發生情況分析. 護理研究, 2018, 32(18): 2971-2973.
15. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology, 1996, 46(5): 1470.
16. Frith J. Diagnosing orthostatic hypotension: a narrative review of the evidence. Br Med Bull, 2015, 115(1): 123-134.
17. Pasma JH, Bijlsma AY, Klip JM, et al. Blood pressure associates with standing balance in elderly outpatients. PLoS One, 2014, 9(9): e106808.
18. Bergman H, Ferrucci L, Guralnik J, et al. Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci, 2007, 62(7): 731-737.
19. Rockwood K, Abeysundera MJ, Mitnitski A. How should we grade frailty in nursing home patients? J Am Med Dir Assoc, 2007, 8(9): 595-603.
20. Pujos-Guillot E, Pétéra M, Jacquemin J, et al. Identification of pre-frailty sub-phenotypes in elderly using metabolomics. Front Physiol, 2019, 9: 1903.
21. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
22. 熊風, 賴玉清, 涂嘉欣, 等. 中國老年人群睡眠障礙流行特征的Meta分析. 中國循證醫學雜志, 2019, 19(4): 28-33.
23. Chen L, Xu Y, Chen XJ, et al. Association between orthostatic hypotension and frailty in hospitalized older patients: a geriatric syndrome more than a cardiovascular condition. J Nutr Health Aging, 2019, 23(4): 318-322.
24. Kocyigit SE, Soysal P, Bulut EA, et al. What is the relationship between frailty and orthostatic hypotension in older adults? J Geriatr Cardiol, 2019, 16(3): 272-279.
25. Wieling W, Schatz IJ. The consensus statement on the definition of orthostatic hypotension: a revisit after 13 years. J Hypertens, 2009, 27(5): 935-938.
26. Benvenuto LJ, Krakoff LR. Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens, 2011, 24(2): 135-144.
27. McDonagh J, Martin L, Ferguson C, et al. Frailty assessment instruments in heart failure: a systematic review. Eur J Cardiovasc Nurs, 2018, 17(1): 23-35.
28. Sze S, Pellicori P, Zhang J, et al. Identification of frailty in chronic heart failure. JACC Heart Fail, 2019, 7(4): 291-302.
29. Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med, 2011, 27(1): 1-15.
30. Sleight C, Holtzer R. Differential associations of functional and cognitive health outcomes with pre-frailty and frailty states in community-dwelling older adults. J Health Psychol, 2020, 25(8): 1057-1063.
31. 司華新, 金雅茹, 喬曉霞, 等. 中文版Tilburg衰弱量表在養老機構老年人中的信效度檢驗. 中國老年學雜志, 2018, 38(16): 4046-4049.
32. Kojima G, Taniguchi Y, Iliffe S, et al. Transitions between frailty states among community-dwelling older people: a systematic review and meta-analysis. Ageing Res Rev, 2019, 50: 81-88.
33. Ostir GV, Ottenbacher KJ, Markides KS. Onset of frailty in older adults and the protective role of positive affect. Psychol Aging, 2004, 19(3): 402-408.
34. Lanziotti Azevedo da Silva S, Campos Cavalcanti Maciel á, de Sousa Máximo Pereira L, et al. Transition patterns of frailty syndrome in comunity-dwelling elderly individuals: a longitudinal study. J Frailty Aging, 2015, 4(2): 50-55.
35. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet, 2013, 381(9868): 752-762.
36. Inouye SK, Studenski S, Tinetti ME, et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc, 2007, 55(5): 780-791.
37. Swift CG, Iliffe S. Assessment and prevention of falls in older people--concise guidance. Clin Med (Lond), 2014, 14(6): 658-662.
38. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens, 2013, 31(10): 1925-1938.

Chinese Journal of Evidence-Based Medicine

Frailty and the risk of orthostatic hypotension: a meta-analysis

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