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Introduction: Orthostatic hypotension (OH) is common and associated with falls among older people. It is defined as a 20 mmHg SBP or 10mmHg DBP drop on active stand. OH is often associated with presyncope and syncope however many people are asymptomatic despite drops in BP consistent with the diagnosis.

Aim: To examine if symptoms or vasodepression during active stand are associated with falling in the last 12 months.

Methods: 269 community-dwelling people age ≥ 65 years underwent active stand. Participant's rested supine for 10 minutes before standing quickly for 3 minutes. BP was recorded using beat to beat monitoring; systolic (or diastolic) vasodepression was defined as the difference between the mean systolic BP over the 20 heart beats before standing minus the BP nadir during standing. Detailed fall history and clinical examination including cognitive function were recorded. Those with MMSE < 26 were excluded from the analysis (n = 27). Logistic regression assessed if symptoms or vasodepression associated with falling.

Results: Sixty-nine subjects reported falling in the previous 12. Fallers were more likely to have a history of hypertension, had poorer scores on Tinetti gate and balance assessment and were more likely to be symptomatic during the active stand. No significant difference occurred in proportion of participants with OH between the two groups and no difference in degree of systolic or diastolic vasodepression between the groups.

Logistic regression showed symptoms during active stand but not systolic vasodepression associated with falling [OR 3.02 (95%CI 1.57, 5.82)] and [OR 1.01 (95% CI 0.99, 1.02)] respectively. Similarly, with diastolic vasodepression; symptoms but not BP drop were associated with falling [OR 3.22 (95% CI 1.67, 6.23)] and [OR 0.98 (95% 0.95, 1.01)]. These findings remained consistent after adjusting for age and sex, and risk factors for falling.

Conclusion: Symptoms during active stand strongly associates with falling rather than vasodepression.

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