Prevalence of orthostatic hypotension and relationship with drug use amongst older patients.

INTRODUCTION: Orthostatic hypotension (OH) is said to be highly prevalent in older people. Drugs are often involved as causative factor. Nevertheless, few data are available about the prevalence of OH and its relationship with drugs in olders. OBJECTIVES: To review data about (i) the prevalence and characteristics of OH in older patients; and (ii) the relationship between OH and drugs. METHODS: Review of publications from Ovid (PubMed) from 1980 to May 2011 using the following key words: "orthostatic hypotension" combined with "elderly" or equivalent for the analysis of prevalence (first search) and "orthostatic hypotension" combined with "drugs" or equivalent to assess the relationship between OH and drugs (second search). RESULTS: Fifty-one publications (of which 14 with original data) were retrieved from the prevalence search, 31 for the second search (8 with original data: 7 retrospective studies and 1 prospective cohort study) and 12 reviews or experts opinions. Prevalence of OH varies according to the characteristics of the subjects, the settings of the studies, and the procedures of blood pressure measurement. In acute geriatrics units, two studies reported a prevalence of over 30% and one study mentioned that 68% of the patients presented with at least one episode during the day. OH was associated with several geriatric problems: gait disorders, balance disorders, falls, cerebral hypoperfusion, transient ischemic attacks, cognitive impairment, acute myocardial infarct and systolic hypertension. OH can also be asymptomatic or with atypical presentation: falls, gait disorders and confusion. Psychotropic agents (antipsychotics, sedatives, antidepressants), and cardiovascular drugs (antihypertensive agents, vasodilators, diuretics) were associated with OH. DISCUSSION: If the hypothesis of causality between drug treatment and OH is confirmed, the identification of the involved drugs could be of value for the prevention of OH and its complications. In this context, the Working Group Pharmacology Pharmacotherapy and Pharmaceutical Care of the Belgian Society of Gerontology and Geriatrics proposes to conduct a multicentre study to assess the prevalence of OH in Belgian acute geriatrics units and its relationship with drugs.

[Validity of the tympanic infrared thermometer in geriatric inpatients]. / De validiteit van de tympane infrarood thermometer bij gehospitaliseerde, geriatrische patiënten.

The purpose of this study was to assess the agreement between rectal temperature and infrared emission detection (IRED). The specificity and sensitivity, the positive predictive value and the negative predictive value were calculated. It was a prospective, observational and unblinded study. Thermoscan-pro-1 was used to collect pairs of data in 41 patients, all hospitalised on an acute geriatric ward during a 4-month period. 41% of the patients were febrile. The 'bias' between rectal and tympanic measurement (left ear) was -0.64 degree C (d) and the standard deviation 0.58 degree C (s). The '95% Confidence Interval' for the bias was -0.82 degree C and -0.46 degree C. The '95% limits of agreement' between the rectal measurement and the tympanic measurement (left ear) was -1.78 degrees C and 0.50 degree C. Regression analysis taught us that bias was increasing with increasing temperature. If we take into account one measurement with the IRED ear thermometry, the sensitivity was 41%, the specificity 83%. The positive predictive value was 64% en the negative predictive value 67%. We can conclude that the IRED ear thermometry is not a valuable alternative for the rectal, digital thermometry in the elderly, frail and febrile hospital inpatients.

Periaortitis and aortic dissection due to Wegener's granulomatosis.

We describe here a patient with abdominal periaortitis and intramural dissection as early manifestations of Wegener's granulomatosis (WG). Surgical biopsies taken from the retroperitoneal inflammatory tissue surrounding the aorta showed granulomatous vasculitis. The patient had antiproteinase-3 antibodies and suffered from nasal, pulmonary, nervous and renal WG involvement. Although being a vasculitis of medium size and small vessels, WG should be included in the systemic vasculitides which can give rise to (peri)aortic inflammation.