Influence of orthostatic hypotension on mortality among patients discharged from an acute geriatric ward.
BACKGROUND
Orthostatic hypotension (OH) is a common finding among older patients. The impact of OH on mortality is unknown.


OBJECTIVE
To study the long-term effect of OH on total and cardiovascular mortality.


METHODS
A total of 471 inpatients (227 males and 244 females), with a mean age of 81.5 years who were hospitalized in an acute geriatric ward between the years 1999 and 2000 were included in the study. Orthostatic tests were performed 3 times during the day on all patients near the time of discharge. Orthostatic hypotension was defined as a fall of at least 20 mmHg in systolic blood pressure (BP) and/or 10 mmHg in diastolic BP upon assuming an upright posture at least twice during the day. Patients were followed until August 31, 2004. Mortality data were taken from death certificates.


RESULTS
One hundred and sixty-one patients (34.2%) experienced OH at least twice. Orthostatic hypotension had no effect on all cause and cause specific mortality. Over a follow-up of 3.47+/-1.87 years 249 patients (52.8%) had died 83 of whom (33.3%) had OH. Age-adjusted mortality rates in those with and without OH were 13.4 and 15.7 per 100 person-years, respectively. Cox proportional hazards model analysis demonstrated that male gender, age, diabetes mellitus, and congestive heart failure increased and high body mass index decreased total mortality.


CONCLUSIONS
Orthostatic hypotension is relatively common in elderly patients discharged from acute geriatric wards, but has no impact on vascular and nonvascular mortality.
Weiss
Avraham
A
Geriatric Department, Rabin Medical Center, Israel.
Beloosesky
Yichayaou
Y
Kornowski
Ran
R
Yalov
Alexandra
A
Grinblat
Joseph
J
Grossman
Ehud
E
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003953:Diagnosis-Related Groups; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007024:Hypotension, Orthostatic / Q000401:mortality*; D008297:Male; D015999:Multivariate Analysis; D009518:New York; D010351:Patient Discharge; D010362:Patients' Rooms; D011300:Preoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists