Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults

J Am Heart Assoc. 2017 May 4;6(5):e005661. doi: 10.1161/JAHA.117.005661.


Background: Impaired orthostatic blood pressure (BP) stabilization is highly prevalent in older adults and is a predictor of end-organ injury, falls, and mortality. We sought to characterize the relationship between postural BP responses and the kidney.

Methods and results: We performed a cross-sectional analysis of 4204 participants from The Irish Longitudinal Study on Ageing, a national cohort of community-dwelling adults aged ≥50 years. Beat-to-beat systolic and diastolic BP were measured during a 2-minute active stand test. The primary predictor was cystatin C estimated glomerular filtration rate (eGFR) categorized as follows (mL/min per 1.73 m2): ≥90 (reference, n=1414); 75 to 89 (n=1379); 60 to 74 (n=942); 45 to 59 (n=337); <45 (n=132). We examined the association between eGFR categories and (1) sustained orthostatic hypotension, defined as a BP drop exceeding consensus thresholds (systolic BP drop ≥20 mm Hg±diastolic BP drop ≥10 mm Hg) at each 10-second interval from 60 to 110 seconds inclusive; (2) pattern of BP stabilization, characterized as the difference from baseline in mean systolic BP/diastolic BP at 10-second intervals. The mean age of subjects was 61.6 years; 47% of subjects were male, and the median eGFR was 82 mL/min per 1.73 m2. After multivariable adjustment, participants with eGFR <60 mL/min per 1.73 m2 were approximately twice as likely to have sustained orthostatic hypotension (P=0.008 for trend across eGFR categories). We observed a graded association between eGFR categories and impaired orthostatic BP stabilization, particularly within the first minute of standing.

Conclusions: We report a novel, graded relationship between diminished eGFR and impaired orthostatic BP stabilization. Mapping the postural BP response merits further study in kidney disease as a potential means of identifying those at risk of hypotension-related events.

Keywords: blood pressure measurement/monitoring; cystatin C; glomerular filtration rate; hypotension; kidney; low blood pressure; orthostatic hypotension.

MeSH terms

  • Age Factors
  • Aged
  • Biomarkers / blood
  • Blood Pressure*
  • Chi-Square Distribution
  • Cystatin C / blood
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Hypotension, Orthostatic / diagnosis
  • Hypotension, Orthostatic / epidemiology
  • Hypotension, Orthostatic / physiopathology*
  • Ireland / epidemiology
  • Kidney / physiopathology*
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Posture*
  • Risk Factors
  • Time Factors


  • Biomarkers
  • CST3 protein, human
  • Cystatin C