Postural Hypotension and Syncope in the Elderly

  • Michael G. Ziegler
  • Richard R. Barager
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 76)


The abrupt loss of consciousness is the second most common reason why people seek emergency medical care. The very old have a 6 percent yearly incidence of syncope, and those who do faint have a recurrence rate of 30 percent [1]. Vasovagal syncope, or the common faint, and psychogenic fainting are relatively less common in the elderly than in young persons. Serious treatable causes of syncope such as postural hypotension and cardiac arrhythmias are more frequent in the old (table 8–1).


Autonomic Nervous System Autonomic Neuropathy Carotid Sinus Vasovagal Syncope Maintain Blood Pressure 


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  1. 1.
    Lipsitz LA, Wei JY, and Rowe JW. Syncope in an elderly, institutionalized population: Prevalence, incidence, and associated risk. Q J Med 55(216):45–54, 1985.PubMedGoogle Scholar
  2. 2.
    Scherokman B and Massey EW. Evaluating loss of consciousness in the elderly. J Amer Geriat Soc 28(11):504–506, 1980.PubMedGoogle Scholar
  3. 3.
    Warlow CP, Blackouts. The Practitioner 224:711–716, 1980.PubMedGoogle Scholar
  4. 4.
    Boudoulas H, Schaal SF, and Lewis RP. Electrophysiologic risk factors of syncope. Electrocardiology 11(4):339–342, 1978.CrossRefGoogle Scholar
  5. 5.
    Simon RP. Syncope and episodic loss of consciousness. Comprehensive Ther 7:19–23, 1981.Google Scholar
  6. 6.
    Palmer GH, Ziegler MG, and Lake CR. Response of norepinephrine and blood pressure increase with age. J Gerontol 33(4):482–487, 1978.PubMedCrossRefGoogle Scholar
  7. 7.
    James TN. Neural control of the heart in health and disease. Adv Int Med 26:317–345, 1980.Google Scholar
  8. 8.
    Lake CR and Ziegler MG. Effects of acute volume alterations on norepinephrine and dopamine-betahydroxylase in normotensive and hypertensive subjects. Circulation 57:774–778, 1978.PubMedCrossRefGoogle Scholar
  9. 9.
    Amer MS. Mechanisms of action of beta blockers in hypertension. Biochem Pharmacol 26:171–175, 1977.PubMedCrossRefGoogle Scholar
  10. 10.
    Ziegler MG, Lake CR, Williams AC, et al. Bromocriptine inhibits norepinephrine release. Clin Pharmacol Ther 25:215–224, 1978.Google Scholar
  11. 11.
    Hale WE, Stewart RB, and Marks RG. Antianxiety drugs and central nervous system symptoms in an ambulatory elderly population. Drug Intel Clin Pharm 19(1):37–40, 1985.Google Scholar
  12. 12.
    Engel GL. Psychologic stress, vasodepressor (vasovagal) syncope and sudden death. Ann Int Med 89:403–412, 1978.PubMedCrossRefGoogle Scholar
  13. 13.
    Ziegler MG. Postural hypotension. Ann Rev Med 31:239–245, 1980.PubMedCrossRefGoogle Scholar
  14. 14.
    Ziegler MG, Lake CR, and Kopin IJ. The sympathetic nervous system defect in primary orthostatic hypotension. N Engl J Med 296:293–297, 1977.PubMedCrossRefGoogle Scholar
  15. 15.
    Ziegler MG. Choosing therapy for postural hypotension. Drug Ther 11(10):97–115, 1981.Google Scholar
  16. 16.
    Ziegler MG and Lake CR. Noradrenergic responses in postural hypotension: Implications for therapy. In CR Lake and MG Ziegler (eds), The Catecholamines in Psychiatric and Neurologic Disorders. Woburn, MA: Butterworth Publishers, 1985, pp 121–136.CrossRefGoogle Scholar
  17. 17.
    Beretta-Piccoli Cand Weidmann P. Metoclopramide alone or combined with flurbiprofen in the treatment of orthostatic hypotension associated with diabetes mellitus. Klin Wochenschr 60:863–865, 1982.PubMedCrossRefGoogle Scholar
  18. 18.
    Walter PF, Crawley IS, and Dorney ER. Carotid sinus hypersensitivity and syncope. Am J Cardiol 42:396–403, 1978.PubMedCrossRefGoogle Scholar
  19. 19.
    Davies AB, Stevens MR, and Davies AG. Carotid sinus hypersensitivity in patients presenting with syncope. Brit Heart J 42:583–586, 1979.PubMedCrossRefGoogle Scholar
  20. 20.
    Cohen FL, Fruehan CT, and King RB. Carotid sinus syncope. J Neurosurg 45:78–84, 1976.PubMedCrossRefGoogle Scholar
  21. 21.
    Morley CA, Perrins EJ, and Sutton R. Alpha-methyldopa and carotid-sinus hypersensitivity. N Engl J Med 305:1418, 1981.PubMedGoogle Scholar
  22. 22.
    Almquist A, Gornick C, Benson W, Jr, et al. Carotid sinus hypersensitivity: Evaluation of the vasodepressor component. Circulation 71:927–936, 1985.PubMedCrossRefGoogle Scholar
  23. 23.
    Jacobson RRand Russell RW. Glossopharyngeal neuralgia with cardiac arrhythmia: A rare but treatable cause of syncope. Br Med J 1: 379–380, 1979.PubMedCrossRefGoogle Scholar
  24. 24.
    Hammill SC, Holmes DR Jr, Wood DL, et al. Electrophysiologic testing in the upright position: Improved evaluation of patients with rhythm disturbances using a tilt table. J Am Coll Cardiol 4(6):703–708, 1985.Google Scholar
  25. 25.
    Doherty JU, Pembrook-Rogers D, Grogen EW, et al. Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncopes. Am J Cardiol 55(6):796–798, 1978.Google Scholar
  26. 26.
    Kapoor WN, Peterson JR, and Karph M. Micturition syncope. A reappraisal. JAMA 253(6):796–798, 1985.CrossRefGoogle Scholar
  27. 27.
    Brick JE, Lowther CM, and Deglin SM. Cold water syncope. Southern Med J 71:1579–1580, 1978.PubMedCrossRefGoogle Scholar
  28. 28.
    Noble RJ. The patient with syncope. JAMA 237:1372–1376, 1977.PubMedCrossRefGoogle Scholar
  29. 29.
    Eagle KA, Black HR, Cook EF, and Goldman L. Evaluation of prognostic classifications for patients with syncope. Am J Med 79(4):455–460, 1985.PubMedCrossRefGoogle Scholar
  30. 30.
    Kapoor WN, Karpf M, Wieand S, et al. A prospective evaluation and follow-up of patients with syncope. N Engl J Med 309:81–83, 1983.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1987

Authors and Affiliations

  • Michael G. Ziegler
  • Richard R. Barager

There are no affiliations available

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