Hospital admissions for orthostatic hypotension and syncope in middle age: insights from the Malmo Preventive Project
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
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 [almost equal to]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.
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 [almost equal to]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.
Date Issued
2016-12-22
Date Acceptance
2016-11-16
Citation
Journal of Hypertension, 2016, 34 (1)
ISSN
1473-5598
Publisher
Wolters Kluwer Health, Inc.
Journal / Book Title
Journal of Hypertension
Volume
34
Issue
1
Copyright Statement
© 2017 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in Journal of Hypertension:
Post Author Corrections: December 22, 2016
doi: 10.1097/HJH.0000000000001215 available at https://dx.doi.org/10.1097/HJH.0000000000001215
Post Author Corrections: December 22, 2016
doi: 10.1097/HJH.0000000000001215 available at https://dx.doi.org/10.1097/HJH.0000000000001215
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000383869506058&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Cardiovascular System & Hematology
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
Publication Status
Published
Coverage Spatial
Rome, ITALY