Key result
First-line antihypertensives were not associated with orthostatic hypotension, whereas alpha blockers increased initial OH (OR 1.80; 95% CI 1.07-3.01) and symptoms (OR 2.64; 95% CI 1.34-5.23).
Why the study?
Orthostatic hypotension is common among older adults prescribed hypertension pharmacotherapy, but reported associations with antihypertensives have been inconsistent due to differences in drug classes and assessment protocols.
Are specific antihypertensive medication classes associated with orthostatic hypotension phenotypes and orthostatic symptoms in older adults?
Observational (n=863)
Are specific antihypertensive medication classes associated with orthostatic hypotension phenotypes and orthostatic symptoms in older adults?
Odds Ratio: 1.8 (95% CI 1.07–3.01)
First-line antihypertensive medications are not associated with orthostatic hypotension or its symptoms in older adults, suggesting they should not be routinely discontinued for non-neurogenic orthostatic hypotension, unlike alpha and alpha-beta blockers which show significant associations.
Supports continuing first-line antihypertensives rather than routine discontinuation for orthostatic hypotension; leaves open whether class-specific deprescribing of alpha blockers reduces falls or syncope.
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.
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Khan et al. (2026) conducted an observational in Orthostatic hypotension (n=863). Antihypertensive medications (first-line, alpha blockers, combined alpha-beta blockers) vs. Non-use of specific antihypertensive class was evaluated on Orthostatic hypotension phenotypes (initial, early, late, sustained) and orthostatic symptoms (OR 1.80, 95% CI 1.07-3.01). First-line antihypertensives were not associated with orthostatic hypotension, whereas alpha blockers increased initial OH (OR 1.80; 95% CI 1.07-3.01) and symptoms (OR 2.64; 95% CI 1.34-5.23).
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