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Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study

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Abstract

Orthostatic hypotension (OH) is a multifactorial disorder, often asymptomatic. The prevalence of OH increases with age, ranging from 5 to 11% among middle-aged patients to 55% in the frail elderly depending on age and associated comorbidities. OH is often unrecognized or misdiagnosed and little is known about its prevalence in hospitalized elderly patients. Our aims were: (1) to determine the prevalence of OH in a cohort of elderly patients hospitalized in two internal medicine wards in Italy; (2) and to describe their characteristics and symptoms. During the 5 months from March 1, 2017 to July 31, 2017, the first 85 consecutive patients (65 years or older) admitted in two internal medicine wards were enrolled. Patients were included in the study if they were able to get out of bed alone or with minor assistance, and able to stand up for at least 3 min. The study population comprised 85 patients with a mean age of 79.6 ( ± 7.2) years. OH was found in 64 (75.3%), occasional OH in 41 (48.2%), persistent OH in 23 (27.1%), and 21 (24.7%) patients had no OH. All patients had diastolic OH and 37 (57.8%) also systolic. Patients with persistent OH were oldest, with a higher percentage of renal failure. Twenty-six patients (40.6%) with OH reported symptoms. Dizziness was the most common symptom, especially after breakfast. No association was found between type of medications and risk of OH. Mortality risk was not statistically different between patients with or without OH 3 (p = 0.10) and 6 months after discharge (p = 0.18), but a trend was observed. We found that OH is very common in the patients admitted in the internal medicine wards, particularly diastolic OH. Close attention should be paid to OH and its symptoms, especially dizziness, in the oldest-old patients, and in patients with renal failure.

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Acknowledgements

The study was voluntary, with no financial support. Sponsor’s role: none. The authors have no conflict of interest. We would like to thank the following people from School of Nursing, ASST Papa Giovanni XXIII Bergamo—University of Milano Bicocca, for their help in carrying out this study: Bianca Maria Botturi, Federica Dattoli, Martina Dell'Amico, Marta Caterina Monno (Nursing Students), Stefano Maestrini (Nurse Educator) and Nadia Colombo (Coordinator of Nursing Program). We are grateful to J.D. Baggott for editorial assistance.

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No funding sources were required for the conduction of this study or the preparation of this article.

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Authors and Affiliations

  1. Pharmacotherapy and Appropriateness of Drug Prescription Unit, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milano, Italy

    Luca Pasina, Laura Cortesi & Mauro Tettamanti

  2. ASST Papa Giovanni XXIII, Bergamo, Italy

    Monica Casati, Ramona Pellegrini & Ivan Oppedisano

  3. Ospedale ‘Città Di Sesto San Giovanni’, Sesto San Giovanni, Italy

    Natale Dugnani, Androula Marinou & Gian Galeazzo Riario Sforza

  4. Dipartimento Di Scienze Biomediche E Cliniche “L. Sacco”, Università Degli Studi Di Milano, Ospedale Fatebenefratelli, Milan, Italy

    Antonio Brucato

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  1. Luca Pasina
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  2. Monica Casati
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  3. Laura Cortesi
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  4. Mauro Tettamanti
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  6. Ivan Oppedisano
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  7. Natale Dugnani
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  8. Androula Marinou
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  9. Gian Galeazzo Riario Sforza
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  10. Antonio Brucato
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Correspondence to Luca Pasina.

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Statement of human and animal rights

The study was approved by the Ethics Committees of the ‘Papa Giovanni XXIII’ hospital and of the ‘Città di Sesto San Giovanni’ hospital. The study was conducted in accordance with Declaration of Helsinki.

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Informed consent was obtained from all individuals participating in the study.

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Pasina, L., Casati, M., Cortesi, L. et al. Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study. Intern Emerg Med 15, 281–287 (2020). https://doi.org/10.1007/s11739-019-02172-7

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  • DOI: https://doi.org/10.1007/s11739-019-02172-7

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