Orthostatic Hypotension in Patient With Hypertension and the Association of Antihypertensive Pharmacology Treatment

Objective: This study aims to assess the prevalence of orthostatic hypotension (OH) and investigate potential associations between OH and specific antihypertensive medication treatments. Design and method: A prospective study with a 1-month follow-up in all hypertension patients being treated with antihypertensive medication, who were manifesting symptoms of suspect OH (lightheadedness, visual disturbances, and presyncope…) at the outpatient clinic of Hue University Hospital. Patients with too high or too low SBP (>180mmHg or <90mmHg); patients with a history or be diagnosed in this visit with ischemic or hemorrhagic stroke; patients with a history of any vestibular disorder; patients with cognitive dysfunction or pregnancy were excluded from the study. Patients with a history of diagnosed OH or postural orthostatic tachycardia syndrome were also excluded. All participants were taken medical history, clinical examination, laboratory tests, and orthostatic BP measure by upper arm automated oscillometric device (OMRON HEM-7600T) seated to standing with a 3-minute delay. OH is diagnosed when a decrease in SBP equal or more than 20 mmHg or DBP equal or more than 10 mmHg. Patients had routine consults and treatment at baseline. After 1 month, all OH patients were re-examined and taken orthostatic BP measurements. Results: Among 642 participants (mean age 61.4 ± 11.4), 122 (19.0%) patients were diagnosed for OH. There were no significant differences between age, sex, history of comorbidities. There are no association between OH and the uncontrolled hypertension ratio as well as the strict of BP control. In antihypertensive agents, the use of CCB (Amlodipine, Lercanidipine in the study) appears to reduce the risk of OH (p <0.001) and vice versa, the use of diuretics (Hydrochlorothiazide; Indapamide in the study) appears to increase the prevalence of OH (p<0.001). These associations were also demonstrated again through multivariate analysis (p=0.041, p=0.003, respectively). The use of 3 antihypertensive agents were also increase the prevalence of OH (p<0.001), although this was not significant in multivariate analysis (p=0.083). Conclusions: Orthostatic hypotension is a common condition in people treated for hypertension with medication. The choice and change of antihypertensive classes should be considered in patients with suspected orthostatic hypotension.