Association of Antihypertensive Medications with Orthostatic Hypotension among OIder Adults
Md Marufuzzaman Khan, Hannah Col, Fredrick Larbi Kwapong, Dhrumil Patil, Mingyu Zhang, Ruth-Alma N Turkson-Ocran, Long H Ngo, Jennifer L Cluett, Kenneth J Mukamal, Elizabeth Selvin, Pamela L Lutsey, B Gwen Windham, Thomas H Mosley, Timothy M Hughes, Lewis A Lipsitz, Josef Coresh, Arielle Valint, Stephen P JuraschekAbstract
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.