Positive screening for orthostatic hypotension in geriatric patients was associated with more frequent discontinuation of antihypertensive medications compared to those without OH (17% vs. 4%, P=0.037).
Observational
Does outpatient screening for orthostatic hypotension reduce prescribed antihypertensive medications in geriatric patients ≥ 65 years?
Screening for orthostatic hypotension in geriatric patients in primary care is associated with increased de-prescribing of antihypertensive medications, potentially reducing polypharmacy.
Absolute Event Rate: 17% vs 4%
p-value: p=0.037
BACKGROUND: To determine if outpatient screening for orthostatic hypotension (OH) in the geriatric population results in fewer prescribed antihypertensive medications and if a relationship exists between OH and specific pharmacologic classes of antihypertensive medications. MATERIALS AND METHODS: Patients ≥ 65 years were screened for OH, defined as a decrease in systolic blood pressure (SBP) ≥ 20 mm Hg or a decrease in diastolic blood pressure (DBP) ≥ 10 mm Hg after standing for 3 minutes. Sitting blood pressure (BP) was measured after patients had been seated quietly in an exam room. Patients then stood for approximately 3 minutes at which time standing BP was recorded. RESULTS: OH prevalence was 18%. Standing DBP was significantly different between the two groups (70 mmHg ± 18, 80 mmHg ± 13, P = 0.007). Compared to patients without OH, patients with OH were more likely to have been previously prescribed beta-blockers (56% vs. 32%, P = 0.056) and potassium-sparing diuretics (11% vs. 1%, P = 0.026). Physicians discontinued an antihypertensive medication more often in patients who screened positive for OH than in to those who did not (17% vs. 4%, P = 0.037). Calcium channel blockers were the most frequently discontinued class of medication. CONCLUSION: Asymptomatic OH is prevalent in geriatric patients. Screening for OH may lead to de-escalation of antihypertensive regimen and a reduction in polypharmacy. Positive screening for OH was associated with de-prescribing of antihypertensive medications. Prior use of beta-blockers and potassium-sparing diuretics was most largely associated with OH.
Kaye et al. (Thu,) conducted a observational in Orthostatic hypotension. Screening for orthostatic hypotension vs. Patients without orthostatic hypotension was evaluated on Discontinuation of an antihypertensive medication (p=0.037). Positive screening for orthostatic hypotension in geriatric patients was associated with more frequent discontinuation of antihypertensive medications compared to those without OH (17% vs. 4%, P=0.037).