Objectives

We aimed to examine to what extent blood pressure (BP) components are associated with injurious falls in older adults, and whether the possible associations differ by functional status (indicated by physical and cognitive impairment at baseline).

Methods

This prospective cohort study included 3055 community-living participants of the Swedish National study on Aging and Care in Kungsholmen (aged ≥60 years). At baseline (2001–2004), we measured systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure, pulse pressure (PP), and orthostatic hypotension. Physical function was assessed using tests of balance, chair stands, and walking speed. Cognitive function was assessed with the Mini-Mental State Examination. Injurious falls leading to inpatient or outpatient care during 3 and 10 years of follow-up were identified via patient registers. Data were analyzed using flexible parametric survival models adjusted for potential confounders.

Results

During the 10-year follow-up period in people without functional impairment, the multi-adjusted hazard ratios (HR) of injurious falls were 1.77 (95% CI 1.02–3.07) for having SBP <130 mmHg, 1.73 (95% CI 1.05–2.83) for having SBP ≥160 mmHg (vs. 130–139), and 1.46 (1.05–2.02) for having higher tertile of PP (vs. lower tertile). During the 3-year follow-up period in people with functional impairment, the multi-adjusted HR of injurious falls was 1.91 (95% CI 1.17–3.13) for having SBP <130 mmHg (vs. 130–139) and 0.74 (0.59–0.94) for having higher tertile of PP (vs. lower tertile). There was no significant association between BP components and injurious falls either in people without functional impairment during the 3-year follow-up period, or in people with functional impairment during the 10-year follow-up period.

Conclusions

This large-scale Swedish study provides evidence that the associations between some specific components of BP and risk of injurious falls in older adults vary by functional status. This supports the view that a personalized approach to blood pressure management depending on functional status among older adults might be warranted in clinical settings.

中文翻译：

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一项研究表明，血压与老年人受伤危险的关联因功能状态而异。

目标

我们的目的是检查血压（BP）成分与老年人伤害性跌倒相关的程度，以及可能的关联是否因功能状态而有所不同（由基线时的身体和认知障碍表示）。

方法

这项前瞻性队列研究包括3055名瑞典国家关于Kungsholmen的衰老和护理的年龄为60岁以上的社区居民。在基线（2001-2004年）时，我们测量了收缩压（SBP）和舒张压（DBP），平均动脉压，脉压（PP）和体位性低血压。使用平衡测试，椅子站立测试和步行速度测试来评估身体机能。认知功能通过迷你精神状态检查进行评估。通过患者登记簿确定了在随访的3年和10年中导致住院或门诊护理的伤害性跌倒。使用针对潜在混杂因素调整的灵活参数生存模型分析数据。

结果

在没有功能障碍的人的10年随访期内，对于SBP <130 mmHg，伤害性跌倒的多重调整风险比（HR）为1.77（95％CI 1.02–3.07），1.73（95％CI 1.05） SBP≥160mmHg（–130–139）时为–2.83），PP的三分位数较高时（相对于三分位数较低）为1.46（1.05–2.02）。在功能受损患者的三年随访期中，对于SBP <130 mmHg（vs. 130-139）和0.74（0.59），经多因素调整的伤害性跌倒的HR为1.91（95％CI 1.17-3.13）。 –0.94）具有较高的PP分位数（相对于较低的三分位数）。在3年的随访期内无功能障碍的人或在10年的随访期间有功能障碍的人，BP成分与伤害下降之间无显着相关性。

结论

这项大规模的瑞典研究提供了证据，表明BP的某些特定组成部分与老年人伤害跌倒的风险之间的关联因功能状态而异。这支持以下观点：在临床环境中可能需要根据老年人的功能状况采取个性化的血压管理方法。