Orthostatic Hypotension As Cause of Syncope in Patients Older Than 65 Years Admitted to Emergency Departments for Transient Loss of Consciousness

Mussi, Chiara; Ungar, Andrea; Menozzi, Carlo; Bartoletti, Angelo; Giada, Franco; Lagi, Alfonso; Ponassi, Irene; Re, Giuseppe; Furlan, Raffaello; Maggi, Roberto; Brignole, Michele

doi:10.1093/gerona/glp028

Cited by 65 publications

(40 citation statements)

References 24 publications

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“…However, the evidence on the relative contribution of each class of medication to the development of OH remains controversial and inconclusive as mentioned previously. 4,8,14,16,18,23,24 Our study did not find any association between medication use and the presence of OH, further suggesting that the differences in hemodynamic responses between the OHN and OHP groups were more likely to be intrinsic and not attributable to any individual medications or clinical conditions.…”

Section: Discussioncontrasting

confidence: 49%

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Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Aung

Corcoran

Nagalingam

et al. 2011

Heart, Lung and Circulation

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Background: Orthostatic hypotension (OH) is prevalent in hospitalized elderly patients. It is defined as a reduction in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg within 3 minutes of standing from a lying position. This observational cohort study describes the prevalence, association with symptoms, and risk factors for OH in medical, surgical, and trauma wards in a tertiary hospital and the differences in hemodynamic behaviors between OH-positive (OHP) and OH-negative (OHN) patients. Methods: All 76 patients who were hemodynamically stable and able to stand from 4 hospital wards had noninvasive supine and orthostatic blood pressures (BPs) and pulse rates (PRs) measured over 4 days. Results: Mean age of the 76 patients included in the study was 67.8 6 19.6 years. Overall prevalence of OH was 23.7% (95% CI: 14.7%-34.8%) with 21.2% (95% CI: 9.0%-38.9%) in medical, 31.8% (95% CI: 13.9%-54.9%) in surgical, and 19.0% (95% CI: 5.4%-41.9%) in trauma wards. OH had no association with symptoms (P 5 .53). We found no differences in age, number of comorbidities, and medication use between the OHN and OHP groups.The two groups displayed very different hemodynamic responses. The OHN group demonstrated a statistically significant compensatory rise in BP and PR over time to orthostatic

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Section: Discussioncontrasting

confidence: 49%

“…According to the literature, up to 28% of syncope events could have been caused by OH. 8,[17][18][19] Hence, it is possible that by excluding this elderly trauma patient population, we might have underestimated the true prevalence of OH in the trauma ward.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Aung

Corcoran

Nagalingam

et al. 2011

Heart, Lung and Circulation

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“…Recurrent falls, often experienced by OH patients, may cause hip fracture and head trauma. Meanwhile, 10% to 31% of patients presenting to emergency departments with syncope are diagnosed with OH-related syncope, [3][4][5] and OH accounts for 0.4% of all hospital admissions. 6 Although OH imposes a heavy burden in terms of medical costs, treatments for OH such as pharmacological pressor agents, elastic lower-limb stockings, and avoidance of rapid postural change remain unsatisfactory.…”

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confidence: 99%

Bionic Baroreceptor Corrects Postural Hypotension in Rats With Impaired Baroreceptor

et al. 2012

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Background-Impairment of the arterial baroreflex causes orthostatic hypotension. Arterial baroreceptor sensitivity degrades with age. Thus, an impaired baroreceptor plays a pivotal role in orthostatic hypotension in most elderly patients. There is no effective treatment for orthostatic hypotension. The aims of this investigation were to develop a bionic baroreceptor (BBR) and to verify whether it corrects postural hypotension. Methods and Results-The BBR consists of a pressure sensor, a regulator, and a neurostimulator. In 35 Sprague-Dawley rats, we vascularly and neurally isolated the baroreceptor regions and attached electrodes to the aortic depressor nerve for stimulation. To mimic impaired baroreceptors, we maintained intracarotid sinus pressure at 60 mm Hg during activation of the BBR. Native baroreflex was reproduced by matching intracarotid sinus pressure to the instantaneous pulsatile aortic pressure. The encoding rule for translating intracarotid sinus pressure into stimulation of the aortic depressor nerve was identified by a white noise technique and applied to the regulator. The open-loop arterial pressure response to intracarotid sinus pressure (nϭ7) and upright tilt-induced changes in arterial pressure (nϭ7) were compared between native baroreceptor and BBR conditions. The intracarotid sinus pressure-arterial pressure relationships were comparable. Compared with the absence of baroreflex, the BBR corrected tilt-induced hypotension as effectively as under native baroreceptor conditions (native, Ϫ39Ϯ5

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“…Syncope can be described as a transient loss of consciousness due to transient global cerebral hypoperfusion, characterized by rapid onset, short duration, loss of tone and spontaneous complete recovery. 1 A literature search performed on definitions of syncope and related disorders found that syncope, neurocardiogenic syncope, neurally mediated syncope, orthostatic intolerance and orthostatic hypotension were defined in only 41,34,26,38 and 48% of papers, respectively, and, when definitions were given, they differed considerably between papers. 2 It is well recognized that syncope presents in a bimodal age distribution with a 3-to 4-fold rise with advancing age.…”

Section: Introductionmentioning

confidence: 99%

Update on syncope in the older person – a clinical review

Mappilakkandy

Edwards

2012

Rev. Clin. Gerontol.

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Syncope is a common cause of presentation to the emergency department in the older population, who are at increased risk of syncope resulting in serious injury in the form of fractures, adverse cardiac outcomes and death, lack of confidence and mental health issues. Older patients can present diagnostic challenges due to multiple co-morbidities, polypharmacy and the problem of amnesia associated with transient loss of consciousness. The underlying cause of their syncope can be established through a structured approach, and targeted patient selection can limit inappropriate investigations in syncope assessment units and ensure appropriate treatments are instituted. A previous review article in this journal, by Nath and Kenny in 2005, examined the evidence surrounding various aspects of syncope, including prevalence, cause, risks, investigations and treatment. This review updates the evidence and guidelines on the aetiology, investigation and treatments of syncope in the older person, with emphasis on recent advances.

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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

Cited by 65 publications

References 24 publications

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Bionic Baroreceptor Corrects Postural Hypotension in Rats With Impaired Baroreceptor

Update on syncope in the older person – a clinical review

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