Introduction: Orthostatic hypotension (OH) is prevalent in hospitalised elderly patients. It can lead to syncope and falls. Age, diabetes, hypertension, multiple co-morbidities and ≥3 antihypertensive medications use have been demonstrated to be risk factors in patients without primary autonomic dysfunction. Our study describes the prevalence, association with symptoms and risk factors for OH in medical, surgical and trauma wards in a tertiary hospital.
Methods: Seventy-six patients from four wards had resting supine and orthostatic blood pressures (BP) and pulse rates (PR) measured over four days.
Results: Patients’ mean age was 67.8 ± 19.6 years.
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| Wards | OH prevalence | 95% confidence intervals |
|---|---|---|
| Overall | 23.7% | 14.7–34.8 |
| Medical | 21.2% | 9.0–38.9 |
| Surgical | 31.8% | 13.9–54.9 |
| Trauma | 19.0% | 5.4–41.9 |
OH had no association with symptoms. OH negative (OHN) and positive (OHP) groups displayed different homeostatic behaviours. OHN group demonstrated statistically significant normal compensatory increases in BP and PR over time to orthostatic challenge. Instead, OHP group demonstrated statistically significant fall in BP over time to standing. They also failed to show compensatory increase in PR, suggesting underlying blunted autonomic responses. There were no differences in age, number of co-morbidities and medication use as risk factors between two groups.
Conclusions: OH is common and mostly asymptomatic. Routine measurements are required to detect cases. Patients with OH displayed altered intrinsic physiologic responses to standing rather than having significant associated risk factors. Further physiologic studies are needed to determine the clinical significance of this for more effective management of OH.
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© 2011 Published by Elsevier Inc.
