Arterial Stiffness Is Associated with Orthostatic Hypotension in Elderly Subjects with History of Falls

Objectives: To test the hypothesis that impaired hemodynamic orthostatic changes commonly observed in the elderly may be related to age-related increase in arterial wall stiffness. Design: Convenience sample of consecutive patients admitted for falls. Setting: Acute- and intermediate-care geriatric ward of a French hospital. Participants: Fifty-seven elderly patients (46 women) consecutively admitted to a geriatric ward with a history of recent falls. Measurements: Orthostatic hypotension (OH) was assessed using blood pressure measurements in the supine position and 1, 2, and 3 minutes after standing. Arterial wall stiffness was assessed using upper-limb and aortic pulse-wave velocities, measured with an external pressure transducer connected to a computer. Results: OH was present in 18 patients with a mean age±standard deviation of 85.4±7.6 (5 men, 13 women) and absent in 39 patients aged 83.7±6.2 (6 men, 33 women). Upper-limb pulse-wave velocity was significantly higher, by 16%, in patients with OH than those without (9.91 vs 8.53 m/s; P<.02). Significant correlations were found between upper-limb pulse-wave velocity and systolic blood pressure changes after 1 minute of standing (r=0.263, P<.05) and maximal diastolic blood pressure change after standing (r=0.351, P<.01). Conclusion: Upper-limb arterial wall stiffness was significantly greater in elderly patients with OH than in patients without OH and was significantly related to blood pressure changes after standing. These results highlight the possible role of age-related changes in the arterial tree in the hemodynamic response to orthostatic challenges.