Orthostatic hypotension and anti-hypertensive therapy in the elderly
Open accessAbstract
Summary: The effect of withdrawing or continuing anti-hypertensive therapy on orthostatic blood pressure change in elderly hypertensive subjects was examined. Subjects meeting criteria for therapy withdrawal had supine and standing blood pressure measurements taken on treatment, and at 1, 3, 6, 9 and 12 months off treatment whilst receiving standard non-pharmacological advice to lower blood pressure. Subjects not meeting blood pressure criteria for treatment withdrawal or were unwilling to stop treatment had blood pressure measurements taken after 6 and 12 months whilst also receiving non-pharmacological advice. Orthostatic hypotension was defined as a mean systolic blood pressure fall > or = 20 mmHg on standing from a supine position. Forty-seven subjects (median age 76 years, range 65-84 years) had treatment withdrawn. Thirteen subjects (median age 73 years, range 68-82 years) continued on their treatment. Twelve months after treatment withdrawal there was a significant reduction in the number demonstrating orthostatic hypotension from 11 (23%) to four (11%) (P < 0.05), whilst the group continuing on treatment showed no change. In the withdrawal group those with orthostatic hypotension on treatment (n = 11) were older (79 versus 74 years, P = 0.05), had higher prewithdrawal systolic blood pressure (164 +/- 21 versus 147 +/- 17 mmHg, P = 0.02) compared to those without, although there was no difference in body mass index, gender, number or type of anti-hypertensive drugs taken. In elderly hypertensive subjects withdrawal of anti-hypertensive therapy and institution of non-pharmacological treatment can over several months reduce the prevalence of orthostatic hypotension.
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Cessation of offending medications is usually key for symptomatic improvement in medication-related syncope.
“Cessation of offending medications is usually key for symptomatic improvement, but often feasibility of cessation of medications is limited by the necessity of the treatments (491–493).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [492]
The Results (page not provided) report that orthostatic hypotension became less common after antihypertensive therapy was withdrawn in elderly hypertensive patients. The paper measures orthostatic blood-pressure changes, not symptomatic improvement or syncope, and does not establish that stopping offending medications is usually key across medication-related syncope. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFeasibility of cessation of offending medications is often limited by the necessity of the treatments.
“Cessation of offending medications is usually key for symptomatic improvement, but often feasibility of cessation of medications is limited by the necessity of the treatments (491–493).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [492]
The Methods (page unavailable) say patients whose blood pressure exceeded the study’s criteria were unsuitable for antihypertensive withdrawal and continued treatment; the Results say 11 of 13 continuing treatment did not meet withdrawal criteria. This supports a treatment-related limit on cessation in this elderly hypertensive group, but not the broader claim that cessation of offending medications is often infeasible because the treatments are necessary. (LLM, conf=0.84)
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Research works printed but not linked: 18
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.002 · Cited by 155 · see citing works
Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes
Van Der Velde, N., Van Den Meiracker, A. H., Pols, H. A. P., Stricker, B. H. C., & Van Der Cammen, T. J. M. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01137.x · Cited by 59 · see citing works
- Authors
- Fotherby, M. D., & Potter, J. F.
- Affiliations
- Glenfield Hospital (GB)
- Corresponding author
- Fotherby, M D
- ORCID
- Potter, J F
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-12-01
- Volume
- 70
- Issue
- 830
- Pages
- 878-881
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- PMC
- PMC2398034
- OpenAlex
- W1975910973
- Cited by
- 54
- References
- 0
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 2 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 7 · 2016: 1 · 2015: 6 · 2012: 2
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Postgraduate Medical Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- orthostatic hypotension, antihypertensive therapy, treatment withdrawal, elderly hypertensive patients
- MeSH terms
- Aged, Aged, 80 and over, Antihypertensive Agents, Female, Follow-Up Studies, Humans, Hypertension, Hypotension, Orthostatic, Male, Prospective Studies, Substance Withdrawal Syndrome
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