Orthostatic hypotension as cause of syncope in patients older than 65 years admitted to emergency departments for transient loss of consciousness.
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.
Mussi
Chiara
C
Department of Geriatrics, University of Modena and Reggio Emilia, Italy. cmussi@iol.it
Ungar
Andrea
A
Salvioli
Gianfranco
G
Menozzi
Carlo
C
Bartoletti
Angelo
A
Giada
Franco
F
Lagi
Alfonso
A
Ponassi
Irene
I
Re
Giuseppe
G
Furlan
Raffaello
R
Maggi
Roberto
R
Brignole
Michele
M
D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D004077:Digoxin / Q000009:adverse effects; D004232:Diuretics / Q000009:adverse effects; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D009566:Nitrates / Q000009:adverse effects; D010300:Parkinson Disease / Q000150:complications; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
D004232:Diuretics; D009566:Nitrates; D004077:Digoxin