Prevalence of orthostatic hypotension among patients presenting with syncope in the ED

• Published in: The American journal of emergency medicine 2002-10, Vol.20 (6), p.497-501
• Main Authors: Sarasin, Francois P., Louis-Simonet, Martine, Carballo, David, Slama, Slim, Junod, Alain-François, Unger, P-F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diagnosis, Differential; Electrocardiography; emergency evaluation; Emergency Medical Services; Female; Follow-Up Studies; Humans; Hypotension, Orthostatic - complications; Hypotension, Orthostatic - diagnosis; Hypotension, Orthostatic - epidemiology; Male; Medical sciences; Middle Aged; orthostatic hypotension; Prevalence; Prospective Studies; prospective study; Recurrence; Survival Analysis; Switzerland - epidemiology; Syncope; Syncope - diagnosis; Syncope - etiology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1053/ajem.2002.34964

We sought to determine the prevalence of orthostatic hypotension as a cause of syncope in the emergency setting, and describe the characteristics of patients diagnosed with this condition. Blood pressure orthostatic changes were measured prospectively in a standardized fashion up to 10 minutes, or until symptoms occurred, in all consecutive patients with syncope as a chief complaint presenting in the emergency department (ED) of a primary and tertiary care hospital. Patients unable to stand-up were excluded. Hypotension was considered to be the cause of syncope when there was: (1) a decrease in systolic blood pressure (SBP) ≥ 20 mm Hg with simultaneous symptoms; (2) a decrease in SBP between 10 and 20 mm Hg, but a SBP ≤ 90 mm Hg with or without symptoms; and (3) a nonsignificant decrease in SBP in the ED, but a prehospital value ≤ 80 mm Hg was documented that prompted fluid therapy before standardized measurements. Among 788 patients with syncope seen in the ED during a 20-month period, 650 were included in the study, and 579 (89%) had standardized measurements of SBP. According to diagnostic criteria, orthostatic hypotension was considered to be the cause of syncope in 156 of them (24%). Fifty-eight patients (37%) had drug-induced hypotension, 33 (21%) hypovolemia, 19 (12%) postprandial hypotension, and 46 (29%) idiopathic hypotension. Asymptomatic SBP changes ≥ 20 mm Hg were found in 10% of patients with syncope attributed to other causes. Compared with patients with vasovagal disorder, those with orthostatic hypotension were older; had more comorbid conditions including hypertension, organic heart disease, and abnormal electrocardiogram; were taking more hypotensive medications; and required more frequently hospitalization (P