1. Acta Clin Belg. 2013 Mar-Apr;68(2):107-12.

Prevalence of orthostatic hypotension and relationship with drug use amongst
older patients.

Pepersack T(1), Gilles C, Petrovic M, Spinnewine A, Baeyens H, Beyer I, Boland B,
Dalleur O, De Lepeleire J, Even-Adin D, Van Nes MC, Samalea-Suarez A, Somers A;
Working Group Clinical Pharmacology, Pharmacotherapy and Pharmaceutical Care;
Belgian Society for Gerontology and Geriatrics.

Author information: 
(1)Service de Geriatrie, Cliniques Universitaires de Bruxelles, Hôpital Erasme.
thierry.pepersack@erasme.ulb.ac.be

INTRODUCTION: Orthostatic hypotension (OH) is said to be highly prevalent in
older people. Drugs are often involved as causative factor. Nevertheless, few
data are available about the prevalence of OH and its relationship with drugs in 
olders.
OBJECTIVES: To review data about (i) the prevalence and characteristics of OH in 
older patients; and (ii) the relationship between OH and drugs.
METHODS: Review of publications from Ovid (PubMed) from 1980 to May 2011 using
the following key words: "orthostatic hypotension" combined with "elderly" or
equivalent for the analysis of prevalence (first search) and "orthostatic
hypotension" combined with "drugs" or equivalent to assess the relationship
between OH and drugs (second search).
RESULTS: Fifty-one publications (of which 14 with original data) were retrieved
from the prevalence search, 31 for the second search (8 with original data: 7
retrospective studies and 1 prospective cohort study) and 12 reviews or experts
opinions. Prevalence of OH varies according to the characteristics of the
subjects, the settings of the studies, and the procedures of blood pressure
measurement. In acute geriatrics units, two studies reported a prevalence of over
30% and one study mentioned that 68% of the patients presented with at least one 
episode during the day. OH was associated with several geriatric problems: gait
disorders, balance disorders, falls, cerebral hypoperfusion, transient ischemic
attacks, cognitive impairment, acute myocardial infarct and systolic
hypertension. OH can also be asymptomatic or with atypical presentation: falls,
gait disorders and confusion. Psychotropic agents (antipsychotics, sedatives,
antidepressants), and cardiovascular drugs (antihypertensive agents,
vasodilators, diuretics) were associated with OH.
DISCUSSION: If the hypothesis of causality between drug treatment and OH is
confirmed, the identification of the involved drugs could be of value for the
prevention of OH and its complications. In this context, the Working Group
Pharmacology Pharmacotherapy and Pharmaceutical Care of the Belgian Society of
Gerontology and Geriatrics proposes to conduct a multicentre study to assess the 
prevalence of OH in Belgian acute geriatrics units and its relationship with
drugs.

PMID: 23967718  [PubMed - indexed for MEDLINE]