***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To determine the prognostic role of orthostatic hypotension for cardiovascular disease ( CVD ) and all-cause mortality in elderly people . DESIGN Prospect i ve study . SETTING Community based . PARTICIPANTS Five thous and sixty-four subjects from the Rotterdam study aged 55 and older . MEASUREMENTS  Orthostatic hypotension  was measured using a Dinamap automatic blood pressure recorder . Orthostatic hypotension  is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to st and ing position at any of three measurements taken 1 , 2 , and 3 minutes after st and ing . RESULTS At baseline , 901 subjects had  orthostatic hypotension  . During follow-up , 668 subjects had  coronary heart disease  ( CHD ) ( mean follow-up 6.0 + /- 3.5 years ) , and 1,835 subjects died ( mean follow-up period 7.8 + /- 3.8 years ) . Orthostatic hypotension increased the risk of CHD ( hazard ratio (HR)=1.31 , 95 % confidence interval (CI)=1.08 - 1.57 ) and all-cause mortality ( HR=1.22 , 95 % CI=1.09 - 1.36 ) , in models adjusted for age and sex . The risk was slightly lower after additional adjustment for cardiovascular risk factors . In analyses stratified for age , the HRs for all-cause mortality were 1.80 ( 95 % CI 1.25 - 2.60 ) , 1.13 ( 0.89 - 1.42 ) , and 1.27 ( 95 % CI=1.11 - 1.44 ) , in the first , second , and third tertile of age , respectively . CONCLUSION Orthostatic hypotension increases the risk of CHD and all-cause mortality in elderly people . The risk of CVD and mortality is strongest in younger and very old subjects Aims Orthostatic hypotension ( OH ) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups , but determinants and consequences of OH in the general population are poorly studied . Methods and results Prospect i ve data of the Swedish ‘ Malmö Preventive Project ’ ( n = 33 346 , 67.3 % men , mean age 45.7 ± 7.4 years , mean follow-up 22.7 ± 6.0 years ) were analysed .  Orthostatic hypotension  was found in 6.2 % of study participants and was associated with age , female gender , hypertension , antihypertensive treatment , increased heart rate , diabetes , low BMI , and current smoking . In Cox regression analysis , individuals with OH had significantly increased all-cause mortality ( in particular those aged less than 42 years ) and coronary event ( CE ) risk . Mortality and CE risk were distinctly higher in those with systolic blood pressure ( BP ) fall ≥30 mmHg [ hazard ratio ( HR ) : 1.6 , 95 % CI 1.3–1.9 , P < 0.0001 and 1.6 , 95 % CI 1.2–2.1 , P = 0.001 ] and diastolic BP fall ≥15 mmHg ( HR : 1.4 , 95 % CI 1.1–1.9 , P = 0.024 and 1.7 , 95 % CI 1.1–2.5 , P = 0.01 ) . In addition , impaired diastolic BP response had relatively greater impact ( per mmHg ) on CE incidence than systolic reaction .  Conclusion Orthostatic hypotension can be detected in ∼6 % of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes . Presence of OH increases mortality and CE risk , independently of traditional risk factors . Although both impaired systolic and diastolic responses predict adverse events , the diastolic impairment shows stronger association with coronary disease OBJECTIVES We investigated the prognostic significance of orthostatic hypotension on the risk of  myocardial infa rct ion ( MI ) amongst the elderly . DESIGN Prospect i ve population -based study . SETTING Home-dwelling population . SUBJECTS Orthostatic testing was performed between 8 a.m. and 2 p.m. , irrespective of having had meals , on 792 persons , representing 82 % of all home-dwelling persons aged > or = 70 years living in five municipalities around the city of Oulu . MAIN OUTCOME MEASURES Occurrence of cases of MI were recorded during mean 3.58 ( SD 1.09 ) years follow-up period , from national mortality statistics and local hospital discharge registers . RESULTS Ninety cases of MI , of which 40 were fatal after initial hospitalization , occurred during the follow-up period . Orthostatic diastolic blood pressure ( BP ) drop 1 min after st and ing up was associated with subsequent MI , but systolic BP reactions had no predictive value . According to the Cox regression model , the strongest predictor of the occurrence of subsequent MI was found in regard to > or = 8 mmHg drop in diastolic BP 1 min after st and ing up ; adjusted for history of MI , diabetes mellitus , chest pain , use of calcium antagonist , beta-blocker , nitrate and diuretic medication , hazard ratio of MI being 2.00 ( 1.11 - 3.59 ) . CONCLUSIONS Orthostatic testing offers a novel means to assess the risk of MI amongst elderly persons .  Diastolic BP drop immediately after st and ing up identifies elderly subjects at a high risk of subsequent MI OBJECTIVES To determine the prospect i ve relationship between blood pressure ( BP ) and cognitive function across a wide age range . DESIGN Prospect i ve population -based cohort study . SETTING The Rotterdam Study and the Leiden 85-plus Study . PARTICIPANTS Three thous and seventy-eight men and women , initial age 55 to 84 from the Rotterdam Study and 276 men and women , initial age 85 , from the Leiden 85-plus Study . MEASUREMENTS  Systolic BP ( SBP ) and diastolic BP ( DBP ) were measured at baseline , cognitive function was assessed at the end of follow-up using a dedicated neuropsychological test battery . The association between baseline BP levels and cognitive function later in life was assessed in 10-year age groups in the Rotterdam Study and in 85-year-olds of the Leiden 85-plus Study . RESULTS In the youngest participants ( < 65 ) , SBP and DBP were not associated with cognitive function 11 years later . For persons aged 65 to 74 , higher baseline SBP and DBP were related to worse cognitive function 11 years later . In contrast , in older age ( > or = 75 ) , higher SBP and DBP seemed to be related to better cognitive function at the end of follow-up . This effect appeared strongest in the highest age group ( aged 85 ) . CONCLUSION High BP was associated with greater risk of cognitive impairment in persons younger than 75 but with better cognitive function  in older persons . Age-specific guidelines for BP management are needed , because the current directive that " lower is better " may not apply to BP levels in the very old Abstract Objective : To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department . Design : R and omised controlled trial . Participants : 274 cognitively impaired older people ( aged 65 or over ) presenting to the accident and emergency department after a fall : 130 were r and omised to assessment and intervention and 144 were r and omised to assessment followed by conventional care ( control group ) .  Setting : Two accident and emergency departments , Newcastle upon Tyne . Main outcome measures : Primary outcome was number of participants who fell in year after intervention . Secondary outcomes were number of falls ( corrected for diary returns ) , time to first fall , injury rates , fall related attendances at accident and emergency department , fall related hospital admissions , and mortality . Results : Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year 's follow up ( 74 % ( 96/130 ) and 80 % ( 115/144 ) , relative risk ratio 0.92 , 95 % confidence interval 0.81 to 1.05 ) . No significant differences were found between groups for secondary outcome measures . Conclusions : Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall . What is already known on this topic Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fall Fall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fall What this study adds No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency department The intervention was less effective in these patients than in cognitively normal older BACKGROUND The prevalence and clinical significance of orthostatic hypertension  ( OHT ) remain largely undetermined in hypertensive patients . This study investigated the association of OHT and  orthostatic hypotension ( OH )  with cardiovascular disease ( CVD ) and target organ damage ( TOD ) in hypertensive patients . METHODS A cross-sectional study was conducted in 4,711 hypertensives and 826 normotensives , aged 40 - 75 years . OHT was defined as an increase in systolic blood pressure ( SBP ) of > or = 20 mm Hg , and OH was defined as either a reduction in SBP of at least 20 mm Hg or a reduction in diastolic BP ( DBP ) of at least 10 mm Hg during the first 3 min after st and ing . RESULTS Hypertension was only independently associated with a risk of OHT . After controlling for age , sex , and other confounders , OH was associated with peripheral artery disease ( PAD ) ( odds ratio ( OR ) 1.49 , 95 % confidence interval ( CI ) 1.15 - 1.89 , P < 0.01 ) , left ventricular hypertrophy ( LVH ) ( OR 1.48 , 95 % CI 1.12 - 1.93 , P < 0.001 ) , coronary artery disease ( CAD ) ( OR 1.71 , 95 % CI 1.12 - 2.61 , P < 0.01 ) , and stroke ( OR 1.72 , 95 % CI 1.19 - 2.34 , P < 0.01 ) , but OHT was only associated with PAD ( OR 1.36 , 95 % CI 1.05 - 1.81 , P < 0.05 ) and stroke ( OR 1.76 , 95 % CI 1.27 - 2.26 , P < 0.01 ) . The adjusted OR for PAD , predicted by the quintiles of the orthostatic SBP changes , showed a J-shaped relationship in untreated hypertensive patients , as was also the case for LVH in hypertensive women . CONCLUSIONS OH is associated with CV risk ; the associations of OHT with TOD and stroke in hypertensive patients still need to be confirmed in prospect i ve studies The prevention of injury associated with falls in older people  is a public health target in many countries around the world . Although there is good evidence that interventions such as multifactorial fall prevention and individually prescribed exercise are effective in reducing falls , the effect on serious injury rates is unclear . Historically , trials have not been adequately powered to detect injury endpoints , and variations in case definition across trials have hindered meta- analysis . It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in population s who are at a higher risk of injury . Further research is required to determine whether fall-prevention interventions can reduce serious injuries . Prevention of Falls Network Europe ( ProFaNE ) is a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice ( www.profane.eu.org ) . The European Commission funds the network , which links clinicians , members of the public , and research ers worldwide . The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity , including clinical trials , comparative research , and prospect i ve meta- analysis . Work is being undertaken in a 4-year program . As a first step , the development of a common set of outcome definitions and measures for future trials or meta- analysis was considered BACKGROUND Orthostatic hypotension ( OH ) is traditionally defined as a decline in systolic or diastolic blood pressure of > 20 or > 10 mm Hg , respectively , after 1 or 3 minutes of upright posture . OH is common in the elderly , but has not been consistently demonstrated to be an independent risk factor for falls in nursing home residents . Previous studies have used the st and ard definition of OH in assessing fall risk . No study has sought to determine if the timing of postural changes in blood pressure adds prognostic value ; if changes in systolic , diastolic , or mean blood pressure are equivalent in predicting subsequent falls ; and what degree of decline in blood pressure has the best predictive value . OBJECTIVE We sought to define the timing and degree of orthostatic changes in blood pressure in a cohort of elder 
    Output:
    
This meta- analysis provides evidence that orthostatic hypotension is associated with a 36 % increase in the risk of overall mortality .
A systematic review of the literature suggests that orthostatic hypotension is also associated with a higher risk for cardiovascular events .