Dear Editor,
We recently read with great interest the article written by Pasina et al. with the title “Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study”, published in a past issue of “Internal and Emergency Medicine” [1]. Orthostatic hypotension affects 20% of the elderly population and it is associated with 35% increased risk in all caused mortality [2, 3]. Although orthostatic hypotension is commonly seen and associated with poor outcomes, it can be overlooked in medical wards. So, the paper is worthy because it draws attention to high prevalence and importance of the orthostatic hypotension.
Although many causes of orthostatic hypotension were evaluated in the study, hemoglobin levels or anemia status of the patients were not discussed. Anemia is a common problem and it is associated with 80% increased mortality rate in hospitalized elderly patients [4]. Anemia may also cause or exacerbate the orthostatic hypotension and it is recommended to be evaluated in case of orthostatic hypotension. Anemia causes reduced systemic vascular resistance, which can result in orthostatic hypotension, by inducing nitric oxide synthesis and decreasing blood viscosity. On the other hand, the authors found that renal failure was a risk factor for persistent orthostatic hypotension in the study. Anemia is also very common in chronic renal failure patients and its incidence increases as glomerular filtration rate decreases. Liu et al. showed that reduced hemoglobin level causes impaired orthostatic blood pressure stabilization in renal failure and reduced hemoglobin can be one of main contributors to orthostatic hypotension in patients with renal failure [5]. Anemia is not only associated with orthostatic hypotension and renal failure, but anemia is also associated with poor outcomes such as frailty, increased hospitalizations rates and increased mortality rates in elderly [4]. To sum up, anemia can be associated with orthostatic hypotension, renal failure and mortality which were evaluated in the study. Anemia and related factors may be examined in another analysis in the cohort of this comprehensive article can be fruitful.
References
Pasina L, Casati M, Cortesi L, Tettamanti M, Pellegrini R, Oppedisano I et al (2020) Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study. Intern Emerg Med 15(2):281–287
Angelousi A, Girerd N, Benetos A, Frimat L, Gautier S, Weryha G et al (2014) Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertens 32(8):1562–1571
Gupta V, Lipsitz LA (2007) Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med 120(10):841–847
Nathavitharana R, Murray J, d'Sousa N, Sheehan T, Frampton C, Baker B (2012) Anaemia is highly prevalent among unselected internal medicine inpatients and is associated with increased mortality, earlier readmission and more prolonged hospital stay: an observational retrospective cohort study. Intern Med J 42(6):683–691
Liu W, Wang L, Huang X, He W, Song Z, Yang J (2019) Impaired orthostatic blood pressure stabilization and reduced hemoglobin in chronic kidney disease. J Clin Hypertens 21(9):1317–1324
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Bolek, H., Bolek, E.C. Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study—comment. Intern Emerg Med 15, 1353–1354 (2020). https://doi.org/10.1007/s11739-020-02441-w
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DOI: https://doi.org/10.1007/s11739-020-02441-w