Abstract
BACKGROUND: Orthostatic hypotension (OH) is common among older adults actively prescribed hypertension pharmacotherapy. Associations between antihypertensives and OH are inconsistent, due to differences in drug classes and OH assessment protocols.
METHODS: Three supine and six standing blood pressures (BPs) were measured over 6 minutes, timed to initiate immediately (0 minutes) and 1, 2, 3, 4, and 5 minutes after standing. OH was defined as a drop of systolic/diastolic BP ≥ 20/10 mmHg upon standing from the supine position. OH phenotypes were initial (immediately after standing), early (within 3 minutes), late (after 3 minutes), and sustained (during 6 minutes of standing). Participants were asked about orthostatic symptoms experienced during OH assessment. We investigated associations of antihypertensive classes with OH phenotypes and orthostatic symptoms via multivariable logistic regression.
RESULTS: Of 863 participants (mean age 84 years), 41% had initial, 24% early, 18% late, and 17% sustained OH; 81% used antihypertensive medications. First-line antihypertensives (renin angiotensin aldosterone system blockers, dihydropyridine calcium channel blockers, and thiazide diuretics) were not associated with OH or orthostatic symptoms. Among non-first-line, alpha blockers were significantly associated with initial OH (OR 1.80, 95%CI 1.07, 3.01) and orthostatic symptoms during postural change (OR 2.64, 95%CI 1.34, 5.23), whereas combined alpha-beta blockers were significantly associated with early, late, or sustained OH (2.24 [1.15, 4.37], 2.50 [1.21, 5.17], 2.99 [1.41, 6.30], respectively) and experienced symptoms while standing (3.08 [1.10, 8.65]).
CONCLUSIONS: First-line antihypertensives are not associated with OH among older adults, which does not support their discontinuation in the setting of non-neurogenic OH.
