Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study: comment
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CE - LETTER TO THE EDITOR
Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study: comment Mario Bo1 · Enrico Brunetti1 Received: 17 March 2020 / Accepted: 25 March 2020 © Società Italiana di Medicina Interna (SIMI) 2020
We really appreciated the recently published paper by Pasina et al. [1], demonstrating a high prevalence of orthostatic hypotension (OH) among internal medicine inpatients, which was not associated with an increased 6-month mortality. We previously reported similar findings in a sample of consecutive inpatients aged ≥ 65 years admitted in an acute geriatric ward (AGW) at the tertiary hospital Molinette, Turin, Italy [2]. For each patient, demographic and clinical variables, number of medications and main drug categories, alongside a Comprehensive Geriatric Assessment (CGA) including indices of comorbidity and global physical health (Cumulative Illness Rating Scale, CIRS), cognitive status (Short Portable Mental Status Questionnaire, SPMSQ), functional autonomy (Activities of Daily Living, ADL, and Instrumental Activities of Daily Living, IADL), and mobility (Timed Up and Go test) were carefully assessed. During the 3-month study period, 343 patients were admitted to the AGW: 148 patients were excluded at admission (118 because of inability to stand or keeping upright position, 26 terminally ill, and 4 with advanced dementia), leaving a final sample of 195 subjects (101 women, mean age 80.1 ± 7.2 years). Prevalence of OH at entry was 52.3%. At discharge the OH test could not be performed in 73 subjects (55 could no more stand or keep the upright position on their own, 6 were transferred to other wards, 6 were deceased and 10 were not cooperating) and among the remaining 122 patients, prevalence of OH was 49%. Interestingly, only 44 subjects showed OH both at admission and at discharge; 16 patients presented OH only at admission while 18 patients at discharge only. Among all the clinical and CGA variables considered, a history of coronary artery disease and of * Enrico Brunetti [email protected] 1
Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Molinette, Corso Bramante 88, 10126 Turin, Italy
neurological disease were the only ones weakly, still independently associated with OH after multivariate adjustment (p = 0.02 and p = 0.03, respectively). There was no difference in the incidence of syncope, falls, post-traumatic fractures, length of stay and mortality during hospital stay and at 6 months after discharge among patients with and without OH [2]. Both our study and that of Pasina et al. [1] showed that OH is common in older medical inpatients. Still, neither study was able to recognize any factor significantly and consistently associated with the presence of OH, including polypharmacy or specific medication classes. Moreover, both studies clearly showed that in hospitalized older subjects OH is more likely to be an inconsistent and fluctua
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