Blood pressure lowering therapy in older people: Does it really cause postural hypotension or falls?

Postgraduate Medicine

Volumn 127, Issue 2, 2015, Pages 186-193

  Zia, Anam ^a   Kamaruzzaman, Shahrul Bahyah ^a   Tan, Maw Pin ^a  

^a UNIVERSITY OF MALAYA   (Malaysia)

Author keywords

Accidental falls; Aged; Antihypertensives; Hypertension; Orthostatic hypotension

Indexed keywords

ANGIOTENSIN RECEPTOR ANTAGONIST; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ANTIHYPERTENSIVE AGENT;

AGED; ANTIHYPERTENSIVE THERAPY; ARTERIAL STIFFNESS; BLOOD PRESSURE REGULATION; CARDIOVASCULAR MORTALITY; DIASTOLIC BLOOD PRESSURE; DISEASE ASSOCIATION; FALLING; HUMAN; ORTHOSTATIC HYPOTENSION; PRACTICE GUIDELINE; PRESCRIPTION; PREVALENCE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SIDE EFFECT; SYSTOLIC BLOOD PRESSURE; CHEMICALLY INDUCED; DOSE RESPONSE; RISK FACTOR; STATISTICS AND NUMERICAL DATA;

ACCIDENTAL FALLS; ANTIHYPERTENSIVE AGENTS; DOSE-RESPONSE RELATIONSHIP, DRUG; HUMANS; HYPOTENSION, ORTHOSTATIC; RISK FACTORS;

EID: 84941003923     PISSN: 00325481     EISSN: 19419260     Source Type: Journal    
DOI: 10.1080/00325481.2015.996505     Document Type: Review

References (56)

1. Yoon SS, Burt V, Louis T, Carroll MD. Hypertension among adults in the United States, 2009–2010. NCHS Data Brief 2012;107:1–8.
2. Lloyd-Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol 2014;43:116–28.
3. Trenkwalder P, Hendricks P, Schoniger R, Rossberg J, Lydtin H, Hense HW. Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population; the prospective STEPHY II study. Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly. Eur Heart J 1999;20:1752–6.
4. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281–357.
5. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 2014;311:507–20.
6. Tan MP, Kenny RA. Cardiovascular assessment of falls in older people. Clin Interv Aging 2006;1:57–66.
7. Centre for disease control and prevention. Falls among older adults: an overview. 2013. Available from http://www.cdc.gov/ HomeandRecreationalSafety/Falls/adultfalls.html. Accessed 10 July 2014.
8. Wu TY, Chie WC, Yang RS, Kuo KL, Wong WK, Liaw CK. Risk factors for single and recurrent falls: a prospective study of falls in community dwelling seniors without cognitive impairment. Prev Med 2013;57:511–17.
9. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35:ii37–41.
10. Van der Velde N, Van den Meiracker AH, Pols HA, Stricker BH, Van der Cammen TJ. Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes. J Am Geriatr Soc 2007;55:734–9.
11. AGS/BGS clinical practice guidelines: prevention of falls in older persons. 2011. Available from http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/ prevention_of_falls_summary_of_recommendations. Accessed 28 March 2014.
12. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonom Neurosci 2011;161:46–8.
13. Bradley JG, Davis KA. Orthostatic hypotension. Am Fam Physician 2003;68:2393–8.
14. Hiitola P, Enlund H, Kettunen R, Sulkava R, Hartikainen S. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens 2009;23:33–9.
15. Rutan GH, Hermanson B, Bild DE, Kittner SJ, LaBaw F, Tell GS. Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension 1992;19:508–19.
16. Coutaz M, Iglesias K, Morisod J. Is there a risk of orthostatic hypotension associated with antihypertensive therapy in geriatric inpatients? Eur Geriatr Med 2012;3:1–4.
17. Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med 1990;113:308–16.
18. Craig GM. Clinical presentation of orthostatic hypotension in the elderly. Postgrad Med J 1994;70:638–42.
19. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701–7.
20. Kario K, Tobin JN, Wolfson LI, et al. Lower standing systolic blood pressure as a predictor of falls in the elderly: a communitybased prospective study. J Am Coll Cardiol 2001;38:246–52.
21. Shibao C, Grijalva CG, Raj SR, Biaggioni I. Orthostatic hypotension-related hospitalizations in the United States. Am J Med 2007;120:975–80.
22. Tan MP, Newton JL, Chadwick TJ, Parry SW. The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case-control study. Europace 2008;10:1400–5.
23. Richardson DA, Bexton RS, Shaw FE, Kenny RA. Prevalence of cardioinhibitory carotid sinus hypersensitivity in patients 50 years or over presenting to the accident and emergency department with "unexplained" or "recurrent" falls. Pacing Clin Electrophysiol 1997;20:820–3.
24. Parry SW, Steen IN, Baptist M, Kenny RA. Amnesia for loss of consciousness in carotid sinus syndrome: implications for presentation with falls. J Am Coll Cardiol 2005;45:1840–3.
25. O’Dwyer C, Bennett K, Langan Y, Fan CW, Kenny RA. Amnesia for loss of consciousness is common in vasovagal syncope. Europace 2011;13:1040–5.
26. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887–98.
27. Fisher AA, McLean AJ, Davis MW, Le Couteur DG. A multicenter, case-control study of the effects of antihypertensive therapy on orthostatic hypotension, postprandial hypotension, and falls in octo- and nonagenarians in residential care facilities. Curr Ther Res Clin Exp 2003;64:206–14.
28. Choulerton J, Mudd P, Mac Mahon M. Withdrawing antihypertensives on the basis of orthostatic hypotension. Age Ageing 2010;39:518.
29. Vischer UM. The treatment of hypertension in very old persons: Benefits and limitations. Eur Geriatr Med 2012;3:33–6.
30. Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing 2010;39:51–6.
31. Valbusa F, Labat C, Salvi P, et al. Orthostatic hypotension in very old individuals living in nursing homes: the PARTAGE study. J Hypertens 2012;30:53–60.
32. Gangavati A, Hajjar I, Quach L, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc 2011;59:383–9.
33. Klein D, Nagel G, Kleiner A, et al. Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM& PP cohort. BMC Geriatr 2013;13:50.
34. Romero-Ortuno R, O’Connell MD, Finucane C, Soraghan C, Fan CW, Kenny RA. Insights into the clinical management of the syndrome of supine hypertension—orthostatic hypotension (SH-OH): the Irish Longitudinal Study on Ageing (TILDA). BMC Geriatr 2013;13:73.
35. Protogerou AD, Stergiou GS, Lourida P, Achimastos A. Arterial stiffness and orthostatic blood pressure changes in untreated and treated hypertensive subjects. J Am Soc Hypertens 2008;2:372–7.
36. Berni A, Ciani E, Cecioni I, Poggesi L, Abbate R, Boddi M. Adherence to antihypertensive therapy affects ambulatory arterial stiffness index. Eur J Intern Med 2011;22:93–8.
37. Perez-Lloret S, Rey MV, Fabre N, et al. Factors related to orthostatic hypotension in Parkinson’s disease. Parkinsonism Relat Disord 2012;18:501–5.
38. Fotherby MD, Potter JF. Orthostatic hypotension and antihypertensive therapy in the elderly. Postgrad Med J 1994;70:878–81.
39. Alsop K, Mac Mahon M. Withdrawing cardiovascular medications at a syncope clinic. Postgrad Med J 2001;77:403–5.
40. van der Velde N, van den Meiracker AH, Pols HA, Stricker BH, van der Cammen TJ. Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes. J Am Geriatr Soc 2007;55:734–9.
41. Verwoert GC, Mattace-Raso FUS, Hofman A, et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 2008;56:1816–20.
42. Fogari R, Zoppi A, Mugellini A, et al. Efficacy and safety of two treatment combinations of hypertension in very elderly patients. Arch Gerontol Geriatr 2009;48:401–5.
43. Zang G. Antihypertensive drugs and the risk of fall injuries: a systematic review and meta-analysis. J Int Med Res 2013;41:1408–17.
44. Kuschel BM, Laflamme L, Moller J. The risk of fall injury in relation to commonly prescribed medications among older people – a Swedish case-control study. Eur J Pub Health 2014. [Epub ahead of print].
45. Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014;174:588–95.
46. Callisaya ML, Sharman JE, Close J, Lord SR, Srikanth VK. Greater daily defined dose of antihypertensive medication increases the risk of falls in older people – a population-based study. J Am Geriatr Soc 2014;62:1527–33.
47. Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med 2012;172:1739–44.
48. van der Velde N, Stricker BH, Pols HA, van der Cammen TJ. Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 2007;63:232–7.
49. Gribbin J, Hubbard R, Gladman JR, Smith C, Lewis S. Risk of falls associated with antihypertensive medication: population-based case-control study. Age Ageing 2010;39:592–7.
50. Wong AK, Lord SR, Sturnieks DL, Delbaere K, Trollor JN, Close JC. Angiotensin system-blocking medications are associated with fewer falls over 12 months in community-dwelling older people. J Am Geriatr Soc 2013;61:776–81.
51. Fotherby MD, Iqbal P. Antihypertensive therapy and orthostatic responses in elderly hospital in-patients. J Hum Hypertens 1997;11:291–4.
52. Ooi WL, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000;108:106–11.
53. Heitterachi E, Lord SR, Meyerkort P, McCloskey I, Fitzpatrick R. Blood pressure changes on upright tilting predict falls in older people. Age Ageing 2002;31:181–6.
54. Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005;30:173–8.
55. Shuto H, Imakyure O, Matsumoto J, et al. Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study. Br J Clin Pharmacol 2010;69:535–42.
56. Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of falls on initiation of antihypertensive drugs in the elderly. Osteoporos Ints 2013;24:2649–57.