Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

Abstract

Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. Methods: Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. Results: One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14–20%; I^2=99%) for 34 community cohorts, 19% (15–25%; I^2=98%) for 23 primary care cohorts and 31% (15–50%; I^2=0%) for 3 residential care or nursing homes cohorts (P=0.16 between groups). By condition, prevalences were 20% (16–23%; I^2=98%) with hypertension (20 cohorts), 21% (16–26%; I^2=92%) with diabetes (4 cohorts), 25% (18–33%; I^2=88%) with Parkinson’s disease (7 cohorts) and 29% (25–33%, I^2=0%) with dementia (3 cohorts), compared to 14% (12–17%, I^2=99%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R^2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P =0.04). Conclusions: PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH.