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Cited by 51Cardiovascular Syncope and Autonomic DisordersBalance, Gait, and Falls PreventionPharmaceutical Practices and Patient Outcomes

Clinical presentation of orthostatic hypotension in the elderly

Open access
Craig, G M·1994·Postgraduate Medical Journal
DOI 10.1136/pgmj.70.827.638PMC PMC2397742
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Abstract

Summary: Fifty cases of orthostatic hypotension in the elderly are analysed. Three main modes of presentation were identified: (1) falls or mobility problems; (2) mental confusion or dementia; or (3) predominantly cardiac symptoms. Selected case histories are given to illustrate diagnostic difficulties. Medication was responsible for orthostatic hypotension in 66% of patients and striking examples of polypharmacy were encountered. However, 34% of cases were not iatrogenic. Only 14% of patients had overtly postural symptoms. A high index of suspicion is needed to diagnose orthostatic hypotension in the elderly and the condition is often overlooked. The paper provides useful diagnostic clues for clinicians.

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  • Syncope related to medication becomes prevalent particularly in older adults.

    “Syncope related to medication becomes prevalent particularly in older adults, who frequently have multiple comorbidities requiring treatment and are prone to polypharmacy effects (488–490).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [488]

    The Summary reports that medication caused orthostatic hypotension in 66% of this elderly case series, and the Discussion describes drug-induced orthostatic hypotension as a major problem in older adults, with polypharmacy a concern. The Discussion identifies fainting as a possible presentation, but the paper does not establish how prevalent medication-related syncope itself is or substantiate the claim that multiple comorbidities require treatment. (LLM, conf=0.83)

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Research works printed but not linked: 13

  1. [3]3. Johnson, R.H. Ageing and the automatic nervous system. In: Bannister, R. & Mathias, C.J. (eds.) Autonomic Failure. Oxford University Press, Oxford, 1992, pp. 882–903.
  2. [2]2. Bannister, R. & Mathias, C.J. Introduction and classification of autonomic disorders. In: Bannister, R. & Mathias, C.J. (eds.) Autonomic Failure. Oxford University Press, Oxford, 1992, pp. 1–11.
  3. [4]4. Watson, R.D.S. Treating postural hypotension. Br Med J 1987, 294: 390–391.
  4. [6]6. Polinsky, R.J. Neuropharmacological investigation of automatic failure. In: Bannister, R. & Mathias, C.J. (eds.) Autonomic Failure. Oxford University Press, Oxford, 1992, pp. 334–358.
  5. [5]5. Shy, G.M. & Drager, G.A. A neurological syndrome associated with orthostatic hypotension. Arch Neurol 1960, 2: 511-527.
  6. [7]7. Bannister, R. & Mathias, C.J. Clinical features and investigation of the primary autonomic failure syndromes. In: Bannister, R. & Mathias, C.J. (eds.) Autonomic Failure. Oxford University Press, Oxford, 1992, pp. 531–547.
  7. [8]8. Gross, M., Bannister, R. & Goodwin-Austen, R. Orthostatic hypotension in Parkinson's disease. Lancet 1972, 1: 174–176. were excluded.16 The risk of hypotension when treating depression in elderly patients with cardiovascular disease has been known for many years.15 Measurement of lying and standing blood pressure should be a routine part of the clinical examination of all patients presenting with falls, all who are at risk from medication, and all who have symptoms or signs such as those listed in Table I. If clinicians had a higher index of suspicion, more patients with treatable orthostatic hypotension would be discovered and much misery could be alleviated.
  8. [9]9. Wilson, J.A. & Smith, R.G. The prevalance and aetiology of long term L-Dopa side effects in elderly parkinsonian patients. Age Ageing 1989, 18: 11–16.
  9. [10]10. Weatherall, D.J., Ledingham, J.G.G. & Warrell, D.A. (eds.) Oxford Textbook of Medicine, Vol. 2. Oxford University Press, Oxford, 1983, 25.8.
  10. [12]12. Davie, J.W., Blumenthal, M.D. & Robinson-Hawkins, S. A model of risk of falling for psychogeriatric patients. Arch Gen Psychiatry 1981, 38: 463–467.
  11. [14]14. Sharma, J.C. & MacLennan, W. Causes of ataxia in patients attending a falls laboratory. Age Ageing 1988, 17: 94–102.
  12. [15]15. Muller, O.F., Goodman, N. & Bellet, S. The hypotensive effect of imipramine hydrochloride in patients with cardiovascular disease. Clin Pharmacol Ther 1961, 2: 300–307.
  13. [16]16. Myers, N.G., Kearns, P.M., Kennedy, D.S. & Fisher, R.H. Postural hypotension and diuretic therapy in the elderly. CMA J 1978, 119: 581–585.

Cited by

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Authors
Craig, G. M.
Affiliations
Northampton Health Authority Formerly Consultant Geriatrician, , UK
Corresponding author
Craig, G M
Venue
Postgraduate Medical Journal
Publisher
Oxford University Press (OUP)
Published
1994-09-01
Volume
70
Issue
827
Pages
638-642
ISSN
  • 0032-5473 (ISSN-L)
  • 1469-0756
DOI
10.1136/pgmj.70.827.638
PMC
PMC2397742
OpenAlex
W2163883077
Cited by
51
References
1
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2021: 1 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 6 · 2016: 1 · 2015: 4 · 2014: 1 · 2013: 3 · 2012: 3
FWCI
3.48
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • Postgraduate Medical Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
orthostatic hypotension, older adults, falls, falls in older adults, dementia, confusion, cardiac symptoms, polypharmacy, diagnostic challenges, clinical features
MeSH terms
Accidental Falls, Aged, Aged, 80 and over, Dementia, Female, Heart Diseases, Humans, Hypotension, Orthostatic, Male

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