Original Contributions
Prevalence of orthostatic hypotension among patients presenting with syncope in the ED*,**,★

https://doi.org/10.1053/ajem.2002.34964Get rights and content

Abstract

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 <.01). We concluded that standardized blood pressure measurement in the ED enabled to strongly implicate orthostatic hypotension as a cause of syncope in 24% of patients with this symptom. Drug-related hypotension was the most frequent cause for this disorder. (Am J Emerg Med 2002;20:497-501. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Methods

Data for this study were collected between 1997 and 2000 as part of a population-based study of patients with syncope.10 The study was conducted in the ED of the Hôpital Cantonal, the main teaching hospital of the University of Geneva School of Medicine and the major primary and tertiary care hospital for the area. On average, 120 patients are seen daily in the ED. All patients ≥ 18 years of age who presented in the ED during the study period with a chief complaint of syncope were considered

Results

Among the 788 patients seen in the ED with a chief complaint of syncope, 650 were enrolled in the study (Fig 1).

. Flow chart summarizing the inclusion of patients.

The causes of syncope were established after the initial evaluation or targeted diagnostic test(s) in 495 patients (76%), and after extensive cardiovascular testing in 30 additional patients. Table 1 lists the spectrum of diseases causing syncope in all study patients.

. Diagnosis of Syncope in Patients Enrolled in the Study (n = 650)

Empty Cell

Discussion

The present study showed that using a standardized protocol in the ED to detect orthostatic blood pressure response revealed that orthostatic hypotension was the likely cause of syncope in 24% of our primary care study population. Our results emphasizes that the simultaneous occurrence of symptoms and orthostatic changes is crucial before to consider orthostatic hypotension to be the probable cause of syncope, the occurrence of asymptomatic changes being frequent among patients in whom other

References (20)

There are more references available in the full text version of this article.

Cited by (0)

*

Supported by grant no. 32-49853.96 from the Swiss National Research Foundation.

**

Address reprint requests to François P. Sarasin, MD, Department of Internal Medicine, Hôpital Cantonal, 24, rue Micheli du Crest, 1211 Geneva 14, Switzerland. E-mail: [email protected]

★

0735-6757/02/2006-0001$35.00/0

View full text
Copyright © 2002 Elsevier Science (USA). Published by Elsevier Inc. All rights reserved.