Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis

Background: Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults. Objective: To provide a prevalence estimate of initial OH in adults aged 65 years or older. Methods: Literature search of MEDLINE (from 1946), Embase (from 1947) and Cochrane Central Register of Controlled Trials was performed until 6 December 2019, using the terms 'initial orthostatic hypotension', 'postural hypotension' and 'older adults'. Articles were included if published in English and participants were 65 years or older. Random effects models were used for pooled analysis. Results: Of 5,136 articles screened, 13 articles (10 cross-sectional; 3 longitudinal) reporting data of 5,465 individuals (54.5% female) from the general (n=4,157), geriatric outpatient (n=1,136), institutionalised (n=55) and mixed (n=117) population were included. Blood pressure was measured continuously and intermittently in 11 and 2 studies, respectively. Pooled prevalence of continuously measured initial OH was 29.0% (95% CI: 22.1-36.9%, I-2 = 94.6%); 27.8% in the general population (95% CI: 17.9-40.5%, I-2 = 96.1%), 35.2% in geriatric outpatients (95% CI: 24.2-48.1%, I-2 = 95.3%), 10.0% in institutionalised individuals (95% CI: 2.4-33.1%, I-2 = 0%) and 21.4% in the mixed population (95% CI: 7.0-49.6, I-2 = 0%). Pooled prevalence of intermittently measured initial OH was 5.6% (95% CI: 1.5-18.9%, I-2 = 81.1%); 1.0% in the general population (95% CI: 0.0-23.9%, I-2 = 0%) and 7.7% in geriatric outpatients (95% CI: 1.8-27.0%, I-2 = 86.7%). Conclusion: The prevalence of initial OH is high in older adults, especially in geriatric outpatients. Proper assessment of initial OH requires continuous blood pressure measurements.