Hypotensive Drugs and Syncope Due to Orthostatic Hypotension in Older Adults with Dementia (Syncope and Dementia Study)

J Am Geriatr Soc. 2018 Aug;66(8):1532-1537. doi: 10.1111/jgs.15421. Epub 2018 Jun 13.

Abstract

Objectives: To determine whether hypotensive drugs may play a pivotal role in inducing orthostatic hypotension (OH)-related syncope.

Design: Prospective, observational, multicenter study.

Setting: Acute care wards, syncope units, and centers for the diagnosis of dementia.

Participants: Individuals aged 65 and older with a diagnosis of dementia and 1 or more episodes of transient loss of consciousness of a suspected syncopal nature or unexplained falls during the previous 3 months MEASUREMENTS: Blood pressure was measured in the supine position and in the orthostatic position after 1 and 3 minutes. OH was defined as a decrease in systolic blood pressure of 20 mmHg or more and in diastolic blood pressure of 10 mmHg or more within 3 minutes of standing. Univariate and multivariate analyses were used to evaluate associations between hypotensive drugs and their combinations with OH-related syncope.

Results: The mean age of the study population (n=522; women, n=324) was 83.5±6.1, and the most frequent comorbidity was arterial hypertension (74.5%); 324 (67.8%) participants had had a syncopal fall and 168 (32.2%) a nonsyncopal fall. The mean number of hypotensive drugs administered (2.9±3.1) did not differ between the two groups. Syncopal falls was OH-related in 170 participants (48.0%). OH-related syncopal falls were more frequent in participants receiving nitrates (15.3% vs 9.8%, p=.06), alpha-blockers (16.5% vs 9.8%, p=.04), or combinations of angiotensin-converting enzyme inhibitors (ACE-Is) and diuretics (20.6% vs 13.0%, p=.04), alpha-blockers and diuretics (8.2% vs 3.3%, p=0.036), and ACE-Is and nitrates (8.2% vs 3.3%, p=.10). Multivariate analysis confirmed a greater risk of OH-related syncopal fall for nitrates (relative risk (RR)=1.77), combinations of ACE-Is and diuretics (RR=1.66), and combinations of ACE-Is and nitrates (RR=2.32).

Conclusion: In older adults with dementia, OH-related syncopal falls are significantly related to treatment with nitrates, combinations of ACE-Is and diuretics, and combinations of ACE-Is and nitrates.

Keywords: dementia; fall; hypotensive drugs; orthostatic hypotension; syncope.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Accidental Falls / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Antihypertensive Agents / adverse effects*
  • Blood Pressure / drug effects
  • Dementia / complications*
  • Dementia / physiopathology
  • Diuretics / adverse effects
  • Female
  • Humans
  • Hypotension, Orthostatic / complications
  • Hypotension, Orthostatic / drug therapy*
  • Hypotension, Orthostatic / physiopathology
  • Male
  • Nitrates / adverse effects
  • Prospective Studies
  • Risk Factors
  • Syncope / chemically induced*

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Diuretics
  • Nitrates