Prevalence and Clinical Implications of Orthostatic Hypotension in Elderly Inpatients

Michela Tibaldi Alessia Brescianini

doi:10.4172/2167-1095.1000155

Abstract

Background: Prevalence of orthostatic hypotension (OH) has been investigated in many studies, mainly on selected samples of subjects. We aimed to assess the prevalence of OH and its association with incidence of adverse events among older medical inpatients. Methods: OH was evaluated according to current guidelines at admission and at discharge among older medical inpatients admitted to a Geriatric acute ward of an university-teaching hospital. A comprehensive clinical (CIRS, Cumulative Illness Rating Scale), functional (ADL, Activities of Daily Living; IADL, Instrumental Activities of Daily Living Scale, TUG, Timed Up and Go) and cognitive (SPMSQ, Short Portable Mental Status Questionnaire) evaluation was performed. Length of stay-in and adverse events (death, institutionalization, falls, syncope, posttraumatic fractures, cardiovascular events) were evaluated at discharge and at 6 months. Results: Among 343 patients admitted, 195 (mean age 80.1 ± 7.2) were enrolled. Prevalence of OH at admission was 52.3%; patients with OH had higher systolic and diastolic blood pressure values (p=0.001 both) and lower heart rate (p=0.02) than patients without OH. Although several conditions were associated with presence of OH, only history of neurological and coronary artery disease were slightly independently associated with OH (p=0.03 and p=0.02, respectively). Prevalence of OH at discharge was 49%. OH was not significantly associated with any adverse event, nor during the hospital stay nor after discharge. Conclusion: OH is extremely common among elderly inpatients, but it was not associated with adverse events. Our results question the utility of routinely screening older medical inpatients for OH.

Highlights

Orthostatic hypotension (OH) is defined as a decline in systolic or diastolic blood pressure of at least 20 and 10 mmHg respectively, while standing up from a lying position within 3 minutes of observation [1]
Among nursing-home residents a wide range of prevalence has been reported (18-50%) [13,14]. Few studies focused their attention on elderly inpatients: Shibao et al, analyzing discharge data from the American Nationwide Inpatient Sample, found that among patients over 75 years the incidence of orthostatic hypotension (OH)-related hospitalizations was 233 on 100000 [15], but the prevalence seems to be much higher in acute geriatric medical wards [16]
We observed that about half of the older patients admitted to an acute Geriatric Ward were diagnosed with OH and our results confirm the high prevalence of OH reported in those few other studies which investigated hospitalized elderly inpatients [16,17,18,27]

Summary

Introduction

Orthostatic hypotension (OH) is defined as a decline in systolic or diastolic blood pressure of at least 20 and 10 mmHg respectively, while standing up from a lying position within 3 minutes of observation [1]. Among nursing-home residents a wide range of prevalence has been reported (18-50%) [13,14]. Few studies focused their attention on elderly inpatients: Shibao et al, analyzing discharge data from the American Nationwide Inpatient Sample, found that among patients over 75 years the incidence of OH-related hospitalizations was 233 on 100000 [15], but the prevalence seems to be much higher in acute geriatric medical wards [16]. Prevalence of orthostatic hypotension (OH) has been investigated in many studies, mainly on selected samples of subjects. We aimed to assess the prevalence of OH and its association with incidence of adverse events among older medical inpatients

Objectives

Methods

Results

Discussion

Conclusion