Huang Jennifer Juxiang, Desai Chirag, Singh Nirmal, Sharda Natasha, Fernandes Aaron, Riaz Irbaz Bin, Alpert Joseph S
University of Arizona at South Campus, Tucson.
University of Arizona at South Campus, Tucson.
Am J Med. 2015 Oct;128(10):1140-3. doi: 10.1016/j.amjmed.2015.05.016. Epub 2015 Jun 4.
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.
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.
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.
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.
虽然已知抗高血压治疗可降低心力衰竭、心肌梗死和中风的风险，但它常常会导致体位性低血压和晕厥，尤其是在联合用药的情况下，以及在炎热干燥的气候条件下可能更易发生。本研究的目的是调查我们之前的一项研究结果，该研究涉及居住在索诺兰沙漠的患者在夏季与冬季以相同剂量持续使用抗高血压药物，是否会导致炎热夏季晕厥发作增加。
纳入所有接受药物治疗且因晕厥被诊断为国际疾病分类第九版编码的高血压患者。这是一项为期3年的回顾性病历审查研究。如果他们在夏季月份（5月至9月）就诊，则定义为“病例组”；如果在冬季月份（11月至3月）就诊，则定义为“对照组”。主要结局指标是临床脱水的存在情况。使用双侧Fisher精确检验确定统计学显著性。
共筛查了834例国际疾病分类第九版编码诊断为晕厥的患者：夏季月份477例，冬季月份357例。在服用抗高血压药物的患者中，夏季因脱水继发晕厥的病例数（40.5%）显著高于冬季（29%）（P = 0.04）。在使用的抗高血压药物类型和晕厥发生率方面未观察到差异。使用的抗高血压药物数量在夏季或冬季均未增加晕厥病例数。
在居住于干燥沙漠气候且服用抗高血压药物的人群中，夏季晕厥事件数量增加。这些数据证实了我们早期的观察结果，即居住在干燥沙漠气候且在夏季服用抗高血压药物的人群中晕厥病例数更多。我们建议对居住在炎热干燥气候地区的患者，尤其是在夏季月份，谨慎减少抗高血压治疗。
