The better investigation of falls and frailty in orthostatic hypotension 2 (BIFFOH-2)

Aims: Primary – Do 24-hour ambulatory blood pressure readings provide a more accurate assessment of postural hypotension in patients admitted with falls or frailty? Secondary – Do other medical diseases or pharmaceutical agents correlate with hypertension or postural hypotension? Methods: Over 12 months within a two year period, 97 geriatric patients were recruited from admissions to a metropolitan hospital geriatrics department. Demographic, medical & pharmaceutical data was collected & frailty scores were calculated using validated methods. Nursing observations were supplemented with readings obtained from an OSCAR-II 24-hour ambulatory blood pressure monitor every half-hourly during daytime & hourly at nighttime. Postural blood pressure readings were collected. Results: There was no difference between blood pressure readings obtained by nurses compared with ABPM readings. Mean systolic and diastolic blood pressures were not lower in those patients admitted with falls or syncope when compared to the control group. We noted several statistically significant associations: mean systolic blood pressure was lower in patients reporting morning dizziness; higher mean systolic blood pressures correlated with a known history of cerebrovascular disease and patients taking anti-hypertensives; lower mean systolic blood pressure was observed in those patients currently taking warfarin. Conclusions: Whilst the primary outcome of this study was not significant, our data highlights an intriguing finding: a statistically significant association between hypotension & warfarin or anti-arrhythmic medications. It is unclear if the hypotensive effect of these medications is cause or effect. Our patient demographic is likely to be representative of most metropolitan geriatric units & we recommend further study into this area.