Development of a simple index, calf mass index, for screening for orthostatic hypotension in community-dwelling elderly

Abstract

The prevalence of orthostatic hypotension (OH) among the community-dwelling elderly is high, but the head-up tilt testing in the laboratory setting is time-consuming and costly. However, an objective index for screening for OH among older people recruited from community settings has not yet been established. Therefore, this study conducted to identify factors that can reveal OH among the elderly recruited from a community setting. A total of 86 people aged ≥ 60 years underwent head-up tilt testing with beats-by-beats blood pressure measurements at Center for elderly fitness and disease/disability prevention research at Nagoya University School of Health Sciences. OH was defined a reduction in systolic blood pressure of at least 20 mmHg or in diastolic blood pressure of at least 10 mmHg within 3 min of raising the head. Associations among anthropometric measurements, fitness parameters and OH were analyzed using multiple logistic regression. Calf mass index (CMI) (OR=0.488, 95% CI; 0.32-0.743, P<0.001) and alpha-blockers (=0.078, 95% CI; 0.007-0.883, P<0.05) were related to OH. The area under the ROC curve was 74.4% (95% CI; 62.8-86.0, P<0.001) and the discriminatory CMI value was 21.2. Our findings suggest that the CMI can be used for screening for OH in the community-dwelling elderly. This information can help clinicians and health care providers working with older people to identify those at risk of OH.