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Postural Blood Pressure Changes and Orthostatic Hypotension in the Elderly Patient

Impact of Antihypertensive Medications

Drugs & Aging volume 22, pages 55–68 (2005)Cite this article

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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Acknowledgements

Dr Ihab Hajjar is the principal investigator for the Palmetto Health Richland site for the multicentre EXCEL (Exelon Caregiver Evaluation Trial) funded by the Novartis Foundation. The study, which tests the use of rivastigmine, is not related to the current manuscript.

No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.

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  1. Division of Geriatrics, Department of Internal Medicine, Palmetto Health Richland and University of South Carolina, 9 Medical Park, Suite 230, Columbia, South Carolina, 29203, USA

    Ihab Hajjar

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Correspondence to Ihab Hajjar.

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Hajjar, I. Postural Blood Pressure Changes and Orthostatic Hypotension in the Elderly Patient. Drugs Aging 22, 55–68 (2005). https://doi.org/10.2165/00002512-200522010-00004

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  • DOI: https://doi.org/10.2165/00002512-200522010-00004

Keywords

  • Chronic Fatigue Syndrome
  • Antihypertensive Medication
  • Orthostatic Hypotension
  • Calcium Channel Antagonist
  • Nebivolol