Orthostatic blood pressure changes and physical, functional and cognitive performance: the MELoR study



Consensus definitions currently define initial orthostatic hypotension (IOH) as ≥ 40 mmHg systolic (SBP) or ≥ 20 mmHg in diastolic blood pressure (DBP) reductions within 15 s of standing, while classical orthostatic hypotension (COH) is defined as a sustained reduction ≥ 20 mmHg SBP or ≥ 10 mmHg SBP within 3 min of standing. The clinical relevance of the aforementioned criteria remains unclear. The present study aimed to determine factors influencing postural blood pressure changes and their relationship with physical, functional and cognitive performance in older adults.


Individuals aged ≥ 55 years were recruited through the Malaysian Elders Longitudinal Research (MELoR) study and continuous non-invasive BP was monitored over 5 min of supine rest and 3 min of standing. Physical performance was measured using the timed-up-and-go test, functional reach, handgrip and Lawton’s functional ability scale. Cognition was measured with the Montreal Cognitive Assessment. Participants were categorized according to BP responses into four categories according to changes in SBP/DBP reductions from supine to standing: < 20/10 mmHg within 3 min (no OH), ≥ 20/10 mmHg from 15 s to 3 min (COH), ≥ 40/20 mmHg within 15 s and ≥ 20/10 mmHg from 15 s to 3 min (COH + IOH) and ≥ 40/20 mmHg within 15 s and < 20/10 mmHg within 3 min (IOH).


A total of 1245 participants were recruited, COH + IOH 623 (50%), IOH 165 (13%) and COH 145 (12%). Differences between groups existed in age, gender, hypertension, diabetes, use of alpha-blocker and/or beta-blocker, ACE-inhibitors, diuretics, biguanides, and baseline systolic BP. In univariate analyses, differences between groups were present in physical performance and cognition. Multivariate comparisons revealed better physical performance in IOH compared to no OH, better physical and cognitive performance in COH + IOH compared to no OH, and cognition in COH than no OH.


Our findings suggest that older adults who fulfil current consensus definitions for IOH had better physical performance and cognitive scores. This indicates that an initial postural BP drop in people aged ≥ 55 years may not necessarily be associated with increased frailty, as suggested by previously published literature.

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The Malaysian Elders Longitudinal Research study was funded by a Ministry of Education High Impact Research Grant (UM.C/625/1/HIR/MOHE/ASH/02). Dr. Nor I’zzati Saedon has also been funded by the Ministry of Education Fundamental Research Grant Scheme (FP010-2016) and a University of Malaya BKP grant (BK010-2016). James Frith is supported by the National Institute of Health Research (NIHR) Clinician Scientist award (NIHR-CS-2014-002). Choon-Hian Goh is supported by the University of Malaya Post-Doctoral Research Fellowship scheme. The views expressed in this publication are those of the authors and not necessarily those of the UK NHS, the NIHR or the UK Department of Health and Social Care.

MELoR investigators

Saedah S, Faculty of Education, University of Malaya. Tey NP, Faculty of Economics, University of Malaya. Siti Zawiah, MD, Centre for Product Design and Manufacturing, Faculty of Engineering, University of Malaya. Khoo SPL, Sports Centre, University of Malaya. Noor Rosly H, Faculty of Built Environment, University of Malaya. Azriyati WNWAA, Faculty of Built Environment, University of Malaya. Ainoriza MA, Faculty of Built Environment, University of Malaya. Chan CS, Faculty of Computer Sciences and Information Technology, University of Malaya. Wee MC, Faculty of Computer Sciences and Information Technology, University of Malaya. Por LY, Faculty of Computer Sciences and Information Technology, University of Malaya. Zaharah H, Faculty of Education, University of Malaya. Norlida A, Faculty of Education, University of Malaya. Firdaus A, Department of Media Studies, Faculty of Arts and Social Sciences, University of Malaya. Siti Zaherah J, Faculty of Law, University of Malaya. Rajasuriar R. Department of Pharmacy, Faculty of Medicine, University of Malaya. Sajaratulnish O. Department of Primary Care Medicine, Faculty of Medicine, University of Malaya . Hairi NN. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Morgan K, School of Medicine, Perdana University-Royal College of Physicians, Serdang, Selangor, Malaysia. Cumming R, School of Public Health, University of Sydney, Australia. Morris T, School of Sport and Exercise Science and Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia. MacKenzie L.Faculty of Health Sciences, University of Sydney, Australia

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Correspondence to Nor Izzati Saedon.

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Saedon, N.I., Frith, J., Goh, CH. et al. Orthostatic blood pressure changes and physical, functional and cognitive performance: the MELoR study. Clin Auton Res 30, 129–137 (2020). https://doi.org/10.1007/s10286-019-00647-3

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  • Orthostatic hypotension
  • Initial orthostatic hypotension
  • Aged
  • Functional impairment
  • Cognition