Citation

Juraschek SP, Appel LJ, Lipsitz LA, Miller ER. J. Am. Geriatr. Soc. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, John Wiley and Sons)

DOI

10.1111/jgs.18113

PMID

36356235

Abstract

We thank the authors for their interest in our work1 and appreciate the challenges with respect to the time and safety of performing a supine-to-stand maneuver in clinic and research settings. Shaw et al. reported that a threshold of 15/7 mm Hg from a seated maneuver was similar to the consensus 20/10 mm Hg threshold from a supine maneuver.2 This finding would suggest that a smaller change in BP from the seated maneuver would be equivalent to a larger change from a supine maneuver. However, our data did not show this; see the scatter plot of the differences in Supplement figure 2 in the original paper. If their findings were true, we would expect that a linear regression of the changes in SBP from a seated maneuver (the independent variable) versus a supine maneuver (the dependent variable) would have a slope greater than 1 (slope = 20/15 or 1.33), particularly in the negative range. In fact, the regression slope was less than 1. Using generalized estimating equations, we found the following slopes: systolic Delta[supine] = 0.38 × Delta[seated] − 5.07; diastolic Delta[supine] = 0.33 × Delta[seated] − 1.68. In the relevant interval, a change in SBP of 0 to −10 mm Hg from the seated maneuver, was comparable to a change of −5 to −12 mm Hg from the supine maneuver. Moreover, if you were to move the −20 mm Hg vertical line over to −10 mm Hg (systolic) or from −10 to −7 mm Hg (diastolic), it is evident that many cases of OH from the supine protocol would still be missed were the Shaw seated thresholds used.

We also reran our regression models with respect to fall risk

Language: en