Overall, only systolic orthostatic hypotension (sOH) was associated with falls, but when recovery time was considered, older adults with Delayed or No Recovery of blood pressure had higher fall risk regardless of the OH definition used.
Key Findings
Results
In 509 community-dwelling older adults from the ActiFE cohort, orthostatic blood pressure changes were common, with OH the most prevalent and systolic OHTN the least.
Study sample: 509 subjects, mean age 79 years, 44% female, 168 falls recorded over 12 months of prospective follow-up.
BP was measured lying, immediately, and 1, 2 and 3 min after standing; sOH/sOHTN defined as SBP drop/increment ≥20 mm Hg, OH/OHTN additionally considering DBP change ≥10 mm Hg.
Results
Systolic orthostatic hypotension, but not the broader OH definition, was associated with at least one fall in adjusted analyses.
sOH showed an adjusted OR of 2.00 (95% CI 1.15-3.47) for at least one fall.
Overall, OH (including diastolic criterion) was not associated with falls.
Logistic regression was adjusted for age, sex, diabetes, hemoglobin, IADL, hand strength, fall risk-increasing drugs, past falls, Falls Efficacy Scale-International and anxiety.
Results
Delayed and absent BP recovery after standing were associated with markedly higher odds of falls among people with OH.
Recovery time categorized as Early Recovery (<1 min), Delayed Recovery (1-3 min), or No Recovery.
For OH: Delayed Recovery OR 3.11 (95% CI 1.21-8.01); No Recovery OR 4.04 (95% CI 1.07-15.26).
Early recovery was the comparison against which risk was elevated in the later categories.
Results
Delayed and absent recovery were also associated with higher fall risk among those with systolic OH.
sOH with Delayed Recovery: OR 4.73 (95% CI 1.71-13.10).
sOH with No Recovery: OR 5.06 (95% CI 1.42-22.27).
Higher risk with delayed/no recovery was seen regardless of the OH definition used.
Results
Orthostatic hypertension was not associated with falls.
Neither systolic OHTN (≥20 mm Hg SBP increment) nor OHTN including the DBP criterion was associated with falls in adjusted models.
Prevalence was 9.0% for sOHTN and 15.5% for OHTN.
What This Means
This study followed 509 community-dwelling older adults (average age 79) for a year to see whether drops or rises in blood pressure on standing up were linked to falls. Blood pressure was measured while lying down and then immediately, and 1, 2 and 3 minutes after standing. About 16.5% had a significant systolic blood pressure drop on standing, and about 27% met a broader definition that also included diastolic drops.
Overall, only the systolic-based definition of orthostatic hypotension was linked to falling, with about twice the odds of at least one fall. The broader definition and orthostatic hypertension (blood pressure rising on standing) were not linked to falls. However, how quickly blood pressure recovered mattered: people whose pressure took 1-3 minutes to recover, or never recovered within 3 minutes, had roughly three to five times the odds of falling compared with those who recovered within a minute, under both definitions.
This research suggests that looking at how long blood pressure takes to return to normal after standing, rather than only whether it drops, may help identify older adults at higher risk of falls. The study is observational, so it shows associations rather than cause and effect, and some confidence intervals were wide because of small subgroups.
Alvarez V, Hertneck C, Rothenbacher D, Denkinger M, Dallmeier D. (2026). Orthostatic blood pressure fluctuations and risk of falls in community-dwelling older adults: the role of recovery time.. BMC geriatrics. https://doi.org/10.1186/s12877-026-08516-1