| Arch Intern Med 2002 Nov 11;162(20):2369-74 |
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| Orthostatic hypotension in acute geriatric ward: is it a consistent
finding |
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| Weiss A, Grossman E, Beloosesky Y, Grinblat J |
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| Geriatric Department, Rabin Medical Center, Golda Campus and Internal
Medicine D Tel Hashomer |
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BACKGROUND: Orthostatic hypotension (OH) is a common finding among
older patients. We designed a study to examine the prevalence and consistency
of OH during the day. METHODS: A total of 502 inpatients (241 men and
261 women) with a mean age of 81.6 years were included in the study.
Orthostatic tests were performed 3 times during the day, 30 minutes
after meals. In 13 patients only 2 sets of measurements were obtained,
and they were omitted from some of the calculations. Orthostatic hypotension
was defined as a fall of at least 20 mm Hg in systolic blood pressure
and/or 10 mm Hg in diastolic blood pressure on assuming an upright
posture. RESULTS: Three hundred thirty-two (67.9%) of 489 patients
experienced OH at least once during the day. Of these, 170 patients
(34.8% of the 489) had OH at least twice (persistent OH) and 162 patients
(33.1%) experienced OH only once (variable OH). Diastolic OH was more
prevalent than systolic OH (57.3% vs 43.4%; P<.001). The intraindividual
consistency of OH was low (kappa = 0.2). Orthostatic hypotension was
observed less frequently during the evening than during the morning
and afternoon (P<.05 vs morning and P =.003 vs afternoon). The difference
between meals' constituents (light vs heavy meals) did not affect the
prevalence of OH. CONCLUSIONS: Orthostatic hypotension is very common
in the elderly, and diastolic OH is more common than systolic OH. The
prevalence of OH is the lowest during the evening, and meals do not
increase the prevalence of OH. The intraindividual consistency of OH
during the day is poor. Thus, in elderly patients, more attention should
be paid to diastolic OH and the diagnosis should be based on repeated
measurements.
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