Lower standing systolic blood pressure as a predictor of falls in the elderly: A community-based prospective study

Objectives We investigated prospectively the relationships among falls, phy sical balance, and standing and supine blood pressure (BP) in elderly perso ns. Background Falls occur often and adversely affect the activities of daily l iving in the elderly; however, their relationship to BP has not been clarif ied thoroughly. Methods A total of 266 community-dwelling elderly persons age 65 years or o ver (123 men and 143 women, mean age of 76 years) were selected from among residents of Coop City, Bronx, New York. Balance was evaluated at baseline using computerized dynamic posturography (DPG). During a one-pear follow-up , we collected information on subsequent Falls on a monthly basis by postca rd and telephone follow-up. Results One or more falls occurred in 60 subjects (22%) during the one-year follow-up. Women fell more frequently than men (28% vs. 16%, p < 0.03), an d fallers were younger than nonfallers. Fallers (n = 60) had lower systolic BP (SBP) levels when compared with nonfallers (n = 200) (128 <plus/minus> 17 vs. 137 + 22 mm Hg for standing, p < 0.006; 137 <plus/minus> 16 vs. 144 +/- 22 mm Hg for lying, p < 0.02), whereas diastolic BP was not related to falls. Falls occurred 2.8 rimes more often in the lower BP subgroup (<140 m m Hg for standing SEP) than in the higher BP subgroup (greater than or equa l to 140 mm Hg, p < 0.0003), and gender-related differences were observed ( p = 0.006): 3.4 times for women (p < 0.0001) versus 1.9 times for men (p = 0.30). Loss of balance, as detected by DPG, did not predict future falls an d was also not associated with baseline BP levels. Multiple logistic regres sion analysis demonstrated that female gender (relative risk [RR] = 2.1, p = 0.02), history of falls (RR = 2.5, p = 9.008) and lower standing SEP leve l(RR = 0.78 for 10 mm Hg increase, p = 0.005) were independent predictors o f falls during one year of follow-up. Conclusions Lower standing SEP, even within normotensive ranges, was an ind ependent predictor of falls in the community-dwelling elderly. Elderly wome n with a history of falls and with lower SEP levels should have more attent ion paid to the prevention of falls and related accidents. (J Am Coll Cardi ol 2001;38:246-52) (C) 2001 by the American College of Cardiology.