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Drugs & Aging
Published in: Drugs & Aging 1/2005

01-01-2005 | Review Article

Postural Blood Pressure Changes and Orthostatic Hypotension in the Elderly Patient

Impact of Antihypertensive Medications

Author: Dr Ihab Hajjar

Published in: Drugs & Aging | Issue 1/2005

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Abstract

With age our ability to maintain haemodynamic homeostasis during position changes becomes less effective. This predisposes elderly patients to significant changes in blood pressure upon standing and orthostatic hypotension (OH). The prevalence of OH varies according to the population being studied. A range of between 5% and 60% has been reported with the lower rate in elderly individuals living in the community and higher rates in those living in an institution or in the acute-care setting.
Multiple factors have been linked to OH including age, bed rest, low body mass index and medications. Although antihypertensive medications can theoretically, as a group, worsen OH, the majority of cross-sectional studies have found no association. In addition, prospective randomised trials have demonstrated an improvement in postural blood pressure (PBP) changes with antihypertensive medications. When considering the individual classes, peripheral vasodilators, specifically α-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate PBP changes and lead to OH. ACE inhibitors, angiotensin-receptor antagonists and β-adrenoceptor antagonists with intrinsic sympathomimetic activity are less likely to worsen OH. Careful management of electrolyte disturbance can decrease the risk of developing OH with diuretic use.
With the aging population, this problem will be encountered by the clinicians at a much higher rate. A detailed patient history, an accurate orthostatic blood pressure measurement and careful evaluation of the autonomic nervous system can provide clinical guidance for management of OH. In hypertensive individuals with no pre-treatment OH, the use of antihypertensive medication can be safe and lead to a low risk of developing OH. In individuals with pre-treatment OH or who develop OH while on antihypertensive medications avoidance of the classes that may exacerbate OH and a judicious use of antihypertensive classes that may improve PBP changes may be safe and adequate treatment.
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Metadata
Title
Postural Blood Pressure Changes and Orthostatic Hypotension in the Elderly Patient
Impact of Antihypertensive Medications
Author
Dr Ihab Hajjar
Publication date
01-01-2005
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 1/2005
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/00002512-200522010-00004

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The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

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