Abstract
Background
While antihypertensive therapy is known to reduce the risk for heart failure, myocardial
infarction, and stroke, it can often cause orthostatic hypotension and syncope, especially
in the setting of polypharmacy and possibly, a hot and dry climate. The objective
of the present study was to investigate whether the results of our prior study involving
continued use of antihypertensive drugs at the same dosage in the summer as in the
winter months for patients living in the Sonoran desert resulted in an increase in
syncopal episodes during the hot summer months.
Methods
All hypertensive patients who were treated with medications and admitted with International
Classification of Diseases, 9th Revision code diagnosis of syncope were included.
This is a 3-year retrospective chart review study. They were defined as “cases” if
they presented during the summer months (May to September) and “controls” if they
presented during the winter months (November to March). The primary outcome measure
was the presence of clinical dehydration. The statistical significance was determined
using the 2-sided Fisher's exact test.
Results
A total of 834 patients with an International Classification of Diseases, 9th Revision
code diagnosis of syncope were screened: 477 in the summer months and 357 in the winter
months. In patients taking antihypertensive medications, there was a significantly
higher number of cases of syncope secondary to dehydration during the summer months
(40.5%) compared with the winter months (29%) (P = .04). No difference was observed in the type of antihypertensive medication used
and syncope rate. The number of antihypertensives used did not increase the cases
of syncope in either summer or winter.
Conclusions
An increased number of syncope events was observed in the summer months among people
who reside in a dry desert climate and who are taking antihypertensive medications.
The data confirm our earlier observations that demonstrated a greater number of cases
of syncope among people who reside in a dry desert climate who were taking antihypertensive
medications during summer months. We recommend judicious reduction of antihypertensive
therapy in patients residing in a hot and dry climate, particularly during the summer
months.
Keywords
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References
- Quality-of-life, health service use, and costs associated with syncope.Prog Cardiovasc Dis. 2013; 55: 370-375
- Prevalence of orthostatic hypotension among patients presenting with syncope in the ED.Am J Emerg Med. 2002; 20: 497-501
- Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Lancet. 1997; 350: 757-764
- Syncope and near-syncope as a multifactorial problem in geriatric inpatients: systemic hypotension is an underrated predictor for syncope exclusively.Adv Med Sci. 2011; 56: 352-360
- Summer syncope syndrome.Am J Med. 2014; 127: 787-790
- The elderly as a sensitive population in environmental exposures: making the case.Rev Environ Contam Toxicol. 2010; 207: 95-157
- A dedicated investigation unit improves management of syncopal attacks (Syncope Study of Unselected Population in Malmo—SYSTEMA I).Europace. 2010; 12: 1322-1328
- Orthostatic hypotension as cause of syncope in patients older than 65 years admitted to emergency departments for transient loss of consciousness.J Gerontol A Biol Sci Med Sci. 2009; 64: 801-806
- Influence of climate on emergency department visits for syncope: role of air temperature variability.PLoS One. 2011; 6: e22719
Article Info
Publication History
Published online: June 04, 2015
Footnotes
Funding: None.
Conflict of Interest: JA's conflict of interest statement is filed with The American Journal of Medicine and Elsevier, but it contains no implications whatsoever for the present study, which was done without any funding from any source and has no possible conflict of interest potential. All other authors have no conflict of interest to report.
Authorship: All authors had access to the data and a role in writing the manuscript. JJH: Primary investigator, conception and design, integration of data, drafting of manuscript. CD: statistical analysis, integration of data, drafting of manuscript. NS: statistical analysis, integration of data, drafting of manuscript. NS: integration of data, drafting of manuscript. IBR: drafting of manuscript. JSA: Conception and design, drafting of manuscript, revising critically for important intellectual content. AF: Integration of data, drafting of manuscript.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
