Background:Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported.Methods:Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-individual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls.Results:Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02–1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17–3.18]) was associated with an increased risk of falls compared with calcium channel blockers.Conclusions:Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail individuals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail individuals might explain some of the variability of previous studies linking blood pressure indices and falls.

中文翻译：

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平均动脉压的变化会增加接受抗高血压药物治疗的老年人身体虚弱和体弱前兆的跌倒风险

背景：脑血流受损与跌倒风险增加有关。据报道，平均动脉压 (MAP) 和 MAP 变异性会影响脑血流量，但之前尚未报道过它们与跌倒风险的关系。方法：利用阿司匹林减少老年试验参与者事件的数据，我们估计MAP 和 MAP 变异性，定义为相对于基线和前 2 次年度就诊的 MAP 个体内 SD。对 16 703 名参与者进行了研究，其中 7.3 年内记录了 1539 次跌倒事件与 MAP 的关系。研究人员对 14 818 名参与者的 MAP 变异性进行了研究，这些参与者在 4.1 年内经历了 974 次跌倒。跌倒仅限于涉及住院的情况。Cox 回归用于计算与跌倒相关的风险比和 95% CI。 结果：MAP 的长期变异性与跌倒无关，但使用抗高血压药物的体弱或体弱前期参与者除外。在该组中，MAP 长期变异性每增加 5 mm Hg，跌倒风险就会增加 16%（风险比，1.16 [95% CI，1.02–1.33]）。在研究的抗高血压药物中，与钙通道阻滞剂相比，β-受体阻滞剂单一疗法（风险比，1.93 [95% CI，1.17-3.18]）与跌倒风险增加相关。结论：MAP 的长期变异性较高增加服用抗高血压药物的年老体弱和体弱前期人士严重跌倒的风险。这种关系仅限于虚弱和预衰弱个体的观察结果可能解释了先前研究将血压指数与跌倒联系起来的一些变异性。