TY - JOUR
T1 - Orthostatic hypotension as cause of syncope in patients older than 65 years admitted to emergency departments for transient loss of consciousness
AU - Mussi, Chiara
AU - Ungar, Andrea
AU - Salvioli, Gianfranco
AU - Menozzi, Carlo
AU - Bartoletti, Angelo
AU - Giada, Franco
AU - Lagi, Alfonso
AU - Ponassi, Irene
AU - Re, Giuseppe
AU - Furlan, Raffaello
AU - Maggi, Roberto
AU - Brignole, Michele
PY - 2009/7
Y1 - 2009/7
N2 - 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 fi fty 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.
AB - 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 fi fty 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.
KW - Adverse drug reaction
KW - Diagnosis
KW - Emergency department
KW - Older
KW - Orthostatic hypotension
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U2 - 10.1093/gerona/glp028
DO - 10.1093/gerona/glp028
M3 - Article
C2 - 19349588
AN - SCOPUS:67649655965
VL - 64
SP - 801
EP - 806
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
SN - 1079-5006
IS - 7
ER -