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Different patterns of orthostatic hypotension in older patients with unexplained falls or syncope: orthostatic hypotension patterns in older people

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Abstract

Purpose

To evaluate different patterns of orthostatic hypotension (OH) and its relation to mortality in older patients with unexplained falls or syncope.

Methods

This is an observational cohort study in consecutive patients aged ≥ 65 years with unexplained falls or syncope at a Fall Syncope day clinic November 2011 until May 2016. OH is defined as a decrease in systolic blood pressure (BP) ≥ 20 mmHg and/or in diastolic BP ≥ 10 mmHg during standing test. Main outcomes are the baseline characteristics and prevalence of patients with classical OH (decrease BP until 3 min), delayed OH (decrease of BP from 5 to 10 min) and continuous OH (decrease of BP for 10 min). Secondary outcome is the relation between different OH patterns and mortality.

Results

Of 374 patients with a mean age of 80 year (SD 6.6), 56% of the patients had OH: 16% had classical OH, 8% delayed OH, 32% had continuous OH and 44% had no OH. Patients with continuous OH and patients with delayed OH tended to have a higher mortality compared to patients with classical OH, 14 vs. 5% (P = 0.07) and 17 vs. 5% (P = 0.06). This possible relation between OH patterns and mortality could not be confirmed in multivariate analysis.

Conclusions

In these very old patients, there are various patterns of decline in standing BP. Delayed and continuous OH will be missed if BP is measured only for 3 min during standing. This is important because patients with continuous OH and delayed OH might have a relation with mortality. Our results encourage additional studies investigating the relation between different OH patterns and mortality.

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Acknowledgements

We thank Els Doejaaren for her help with collecting the data and T. van der Ploeg, statistician, for his assistance with the statistical analysis of the data.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Elizabeth J. Roosendaal, Simone J. Moeskops & René W. M. M. Jansen

  2. Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands

    Tjeerd Germans & Jaap H. Ruiter

Authors
  1. Elizabeth J. Roosendaal
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  2. Simone J. Moeskops
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Correspondence to René W. M. M. Jansen.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee.

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Informed consent was obtained from all individual participants included in the study.

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Roosendaal, E.J., Moeskops, S.J., Germans, T. et al. Different patterns of orthostatic hypotension in older patients with unexplained falls or syncope: orthostatic hypotension patterns in older people. Eur Geriatr Med 9, 485–492 (2018). https://doi.org/10.1007/s41999-018-0063-1

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  • DOI: https://doi.org/10.1007/s41999-018-0063-1

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