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Olle Melander

Principal investigator

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Hospital admissions for orthostatic hypotension and syncope in later life : insights from the Malmö Preventive Project

Author

  • Fabrizio Ricci
  • Lamberto Manzoli
  • Richard Sutton
  • Olle Melander
  • Maria E. Flacco
  • Sabina Gallina
  • Raffaele de Caterina
  • Artur Fedorowski

Summary, in English

OBJECTIVE(S):: We explored incidence, predictors, and long-term prognosis of hospital admissions attributed to reflex syncope and orthostatic hypotension. METHODS:: We analyzed a cohort of 32?628 individuals (68.2% men; age, 45.6?±?7.4 years) without prevalent cardiovascular disease over a follow-up period of 26.6?±?7.5 years. RESULTS:: One thousand and fourteen persons (3.1%, 1.2 per 1000 person-years) had at least 1 hospitalization for orthostatic hypotension (n?=?462, 1.42%) or syncope (n?=?632, 1.94%). Orthostatic hypotension-related hospitalizations were predicted by age [per 1-year increase, hazard ratio 1.14, 95% confidence interval (CI): 1.12–1.16], smoking (hazard ratio 1.35, 95% CI: 1.12–1.64), diabetes (hazard ratio 1.50, 95% CI: 1.00–2.25), baseline orthostatic hypotension (hazard ratio 1.45, 95% CI: 1.05–1.98), in particular, by SBP fall at least 30?mmHg (hazard ratio 3.93, 95% CI: 2.14–7.23), whereas syncope hospitalizations by age (per 1-year increase, hazard ratio 1.09, 95% CI: 1.07–1.11), smoking (hazard ratio 1.27, 95% CI: 1.08–1.49), and hypertension (hazard ratio 1.42, 95% CI: 1.20–1.69). Both syncope-hospitalized and orthostatic hypotension hospitalized patients had higher burden of hospital admissions for other reasons such as cardiovascular, pulmonary, renal disease, or diabetes. During the follow-up, 10?727 (32.9%) died, with 419 deaths preceded by syncope/orthostatic hypotension hospitalization. After adjustment for traditional risk factors, syncope-hospitalization predicted all-cause mortality (hazard ratio 1.16, 95% CI: 1.02–1.31), whereas orthostatic hypotension hospitalization predicted cardiovascular mortality (hazard ratio 1.13, 95% CI: 1.07–1.19). CONCLUSION:: Hospital admissions due to syncope and orthostatic hypotension occur in ≈3% of older individuals and increase with age and comorbidities. Admissions due to syncope are associated with prevalent hypertension, whereas those due to orthostatic hypotension overlap with diabetes and previously identified orthostatic hypotension. Syncope-related admissions predict higher all-cause mortality, whereas orthostatic hypotension-related admissions herald increased cardiovascular mortality.

Department/s

  • Cardiovascular Research - Hypertension
  • EXODIAB: Excellence in Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health

Publishing year

2017

Language

English

Pages

776-783

Publication/Series

Journal of Hypertension

Volume

35

Issue

4

Document type

Journal article

Publisher

Lippincott Williams & Wilkins

Topic

  • Cardiac and Cardiovascular Systems

Status

Published

Research group

  • Cardiovascular Research - Hypertension

ISBN/ISSN/Other

  • ISSN: 0263-6352