Key result
In the absence of controlled-trial evidence, managing combined hypertension and orthostatic hypotension in older patients may involve gradual-onset antihypertensives and lower-limb compression.
Why the study?
How should clinicians manage blood pressure to provide cardiovascular risk protection without predisposing to syncope in older patients with combined hypertension and orthostatic hypotension?
How should clinicians manage blood pressure to provide cardiovascular risk protection without predisposing to syncope in older patients with combined hypertension and orthostatic hypotension?
In the absence of trial data, managing older patients with both hypertension and orthostatic hypotension requires a cautious approach using low-dose, gradual-onset antihypertensives and physical counter-maneuvers.
Cautious use of gradual antihypertensives and compression is warranted in older patients with hypertension and orthostatic hypotension; leaves open the need for randomized trials.
The combination of hypertension and orthostatic hypotension in older individuals is becoming increasingly recognized. Managing this combination of disorders presents a treatment dilemma -- how to lower blood pressure to provide cardiovascular risk protection without predisposing to syncope. At present, there is no specific evidence base available with regard to managing such patients. Some antihypertensive drug classes (e.g., alpha-blockers) appear more problematic in this regard than others. In the absence of controlled-trial evidence, use of antihypertensives with a more gradual onset of effect commenced at lower doses and use of lower-limb compression hosiery appears to be a reasonable approach. Abdominal compression devices and elevating the head of the bed may also help to combat orthostatic hypotenstion in older patients with hypertension and warrant future research.
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Lee et al. (2005) conducted a review in Combined hypertension and orthostatic hypotension. Gradual onset antihypertensives and lower-limb compression hosiery was evaluated. In the absence of controlled-trial evidence, managing combined hypertension and orthostatic hypotension in older patients may involve gradual-onset antihypertensives and lower-limb compression.
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