Evaluation of Patients with Syncope in the Emergency Department: How to Adjust Pharmacological Therapy

Abstract

The rate of syncope in the Emergency Department ranges between 0.9 and 1.7%. Syncope is mostly related to a underlying reflex or orthostatic mechanism. A bradycardic or a hypotensive phenotype, may be identified. The latter is the most common and could be constitutional or drug induced. Consequently, obtaining an accurate drug history is an important step of the initial assessment of syncope. As anti-hypertensive medication might be responsible for orthostatic hypotension, managing hypertension in patients with syncope requires finding an ideal balance between hypotensive and cardiovascular risks. The choice of anti-hypertensive molecule as well as the therapeutic regimen and dosage, influences the risk of syncope. Not only could anti-hypertensive drugs have a hypotensive effect but opioids and psychoactive medications may also be involved in the mechanism of syncope. Proper drug management could reduce syncope recurrences and their consequences.

Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study

“…Despite these premises, frailty has been poorly investigated in hypertensive patients [ 23 , 24 ] and only two randomized controlled trials have included frailty identification while assessing the prognostic impact of antihypertensive treatment in geriatric patients [ 25 , 26 ]. A multitude of frailty instruments exists in the literature [ 27 ], but as different tools capture different types of patients [ 28 ], it is still unknown as to which tool best informs clinical decisions on BP management in older patients.…”