HDCN Article Review/Hyperlink

Masuo K, Mikami H, Ogihara T, Tuck MD

Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications

Am J Hypert (Mar) 9:263-268 1996

Choice of antihypertensive medication in the elderly is often complicated by the development of orhthostatic hypotension. The authors treated 50 normotensive and 50 hypertensive subjects with one of 5 different medications in a double blinded fashion.

Blood pressure measurements were taken after an equilibration time of 2 minutes standing and 10 minutes supine over intervals spanning 2 years. Interestingly, over 25 percent of patients exhibited at least a 10% fall in mean BP regardless of the category of medication used (nifedipine, metoprolol, enalapril, prazosin, or thiazide) and, not surprisingly, this effect worsened with increasing age and dosage of medication. Orthostatic changes did, however, decrease with time and normalization of blood pressure in hypertensive patients. Elderly subjects with orthostatic hypotension were more likely to have a diminished ratio of standing to supine plasma norepinephrine hinting once again at the clinical suspicion that this population has an attenuated sympathetic nerve activity response to change in posture.

Comment: For clinicians, the take home point of this study is that all classes of antihypertensive medications in the elderly carry a real and perceptible risk of orthostatic hypotension at initiation. These changes often improves with time and normalization of blood pressure. (Sri Narsipur, MD, SUNY-HSC at Syracuse, NY)