The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on April 6, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/glp028
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Orthostatic Hypotension As Cause of Syncope in Patients Older Than 65 Years Admitted to Emergency Departments for Transient Loss of Consciousness
1 Department of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
2 Department of Geriatrics, Ospedale Careggi and University of Florence, Florence, Italy
3 Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy
4 Department of Cardiology, Nuovo Osp. S. Giovanni di Dio, Florence, Italy
5 Department of Cardiology, Ospedale Umberto I, Mestre, Italy
6 Department of Emergency Medicine, Ospedale S. Maria Nuova, Florence, Italy
7 Department of Emergency Medicine, Ospedale S. Martino, Genova, Italy
8 Department of Emergency Medicine, Policlinico S. Orsola Malpighi and University of Bologna, Bologna, Italy
9 Internal Medicine II, Ospedale L. Sacco and University of Milan, Milan, Italy
10 Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
Address correspondence to Chiara Mussi, MD, PhD, Department of Geriatrics, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, Via Giardini 1135, 41100 Baggiovara di Modena, Italy. Email: cmussi{at}iol.it
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Abstract |
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Background: Syncope due to orthostatic hypotension (OH) refers to loss of consciousness caused by hypotension induced by the upright position; it is an important risk factor for fall-related physical injuries, especially in the elderly adults. We evaluated the prevalence of OH syncope and the clinical characteristics of patients older than 65 years with syncope due to OH in the Evaluation of Guidelines in Syncope Study 2 group population.
Methods: Two hundred fifty nine patients older than 65 years consecutively admitted to the emergency department because of loss of consciousness in a period of a month were submitted to a standardized protocol approved by the European Task Force for the diagnosis of syncope; all the patients were studied by a trained physician who interacted with a central supervisor as the management of syncope was concerned, using a decision-making software.
Results: Prevalence of OH syncope was 12.4%. Patients with OH syncope were more likely to be affected by Parkinson’s disease and by other neurological diseases. ST changes and longer values of QTc were found in OH syncope group, and they took a greater number of diuretics, nitrates, and digoxin. In multivariate analysis, Parkinson’s disease (p = .001) and use of nitrates (p = .001) and diuretics (p = .020) were independently related to OH syncope.
Conclusions: In patients older than 65 years, Parkinson’s disease and neurological comorbidity are strictly related to OH syncope. Moreover, this study suggests the independent link between OH syncope and the use of vasoactive drugs, identifying the majority of cases as adverse drug reaction, a preventable risk factor for syncope and falls in the older population.
Keywords Orthostatic hypotension; Older; Emergency department; Diagnosis; Adverse drug reaction
Received: January 19, 2009; Accepted: February 4, 2009
* The investigators in the Evaluation of Guidelines in Syncope Study 2 are listed in Appendix 1.