Hypertension and Orthostatic Hypotension in the Elderly: a Challenging Balance

Overview

Journal Lancet Reg Health Eur

Specialty Health Services

Date 2024 Dec 24

PMID 39717228

Authors

Julia Wiersinga

Sofie Jansen

Mike J L Peters

Hanneke F M Rhodius-Meester

Marijke C Trappenburg

Jurgen A H R Claassen

Majon Muller

Affiliations

Soon will be listed here.

Abstract

Hypertension and orthostatic hypotension (OH) frequently coexist in the older population, both stemming from impaired blood pressure (BP) regulation. Managing hypertension in patients with OH presents a significant clinical challenge, particularly in frail older adults who are also prone to falls. Hypertension treatment is often suboptimal in this population due to concerns over the potential increased risk of falls associated with treatment. However, current clinical guidelines provide limited guidance on managing this complex issue. This review explores the pathophysiology of hypertension and OH, reviews existing guidelines, and examines the evidence surrounding hypertension management in patients with OH. Additionally, we provide an overview of research focused on frail older adults and offer expert-opinion-based recommendations for the management of hypertension and OH in routine clinical practice.

References

Juraschek S, Hu J, Cluett J, Ishak A, Mita C, Lipsitz L . Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension : A Systematic Review and Individual Participant-based Meta-analysis. Ann Intern Med. 2020; 174(1):58-68. PMC: 7855528. DOI: 10.7326/M20-4298. View

Hohtari-Kivimaki U, Salminen M, Vahlberg T, Kivela S . Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up. J Am Med Dir Assoc. 2021; 22(11):2325-2330. DOI: 10.1016/j.jamda.2021.07.010. View

Sunayama T, Maeda D, Matsue Y, Kagiyama N, Jujo K, Saito K . Prognostic value of postural hypotension in hospitalized patients with heart failure. Sci Rep. 2022; 12(1):2802. PMC: 8857283. DOI: 10.1038/s41598-022-06760-0. View

Rivasi G, Rafanelli M, Mossello E, Brignole M, Ungar A . Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications. Drugs Aging. 2020; 37(10):725-738. PMC: 7524811. DOI: 10.1007/s40266-020-00796-5. View

Tomiyama H, Matsumoto C, Kimura K, Odaira M, Shiina K, Yamashina A . Pathophysiological contribution of vascular function to baroreflex regulation in hypertension. Circ J. 2014; 78(6):1414-9. DOI: 10.1253/circj.cj-14-0064. View

Juraschek S, Cluett J, Belanger M, Anderson T, Ishak A, Sahni S . Effects of Antihypertensive Deprescribing Strategies on Blood Pressure, Adverse Events, and Orthostatic Symptoms in Older Adults: Results From TONE. Am J Hypertens. 2021; 35(4):337-346. PMC: 8976175. DOI: 10.1093/ajh/hpab171. View

Shibao C, Grijalva C, Raj S, Biaggioni I, Griffin M . Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007; 120(11):975-80. DOI: 10.1016/j.amjmed.2007.05.009. View

Ylitalo A, Airaksinen K, Sellin L, Huikuri H . Effects of combination antihypertensive therapy on baroreflex sensitivity and heart rate variability in systemic hypertension. Am J Cardiol. 1999; 83(6):885-9. DOI: 10.1016/s0002-9149(98)01067-4. View

Cushman W, Evans G, Byington R, Goff Jr D, Grimm Jr R, Cutler J . Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362(17):1575-85. PMC: 4123215. DOI: 10.1056/NEJMoa1001286. View

10.

Weijs R, de Roos B, Thijssen D, Claassen J . Intensive antihypertensive treatment does not lower cerebral blood flow or cause orthostatic hypotension in frail older adults. Geroscience. 2024; 46(5):4635-4646. PMC: 11335707. DOI: 10.1007/s11357-024-01174-4. View

11.

Staessen J, Fagard R, Thijs L, Celis H, Arabidze G, Birkenhager W . Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997; 350(9080):757-64. DOI: 10.1016/s0140-6736(97)05381-6. View

12.

Materson B, Garcia-Estrada M, Preston R . Hypertension in the frail elderly. J Am Soc Hypertens. 2016; 10(6):536-41. DOI: 10.1016/j.jash.2016.03.187. View

13.

Camafort M, Kario K . Hypertension, heart failure, and frailty in older people: A common but unclear situation. J Clin Hypertens (Greenwich). 2020; 22(10):1763-1768. PMC: 8029958. DOI: 10.1111/jch.14004. View

14.

Kaye M, Rutowski J, Aftab H, Pandey R, Khan R, Kalot M . Screening for orthostatic hypotension in the geriatric population in a real-world primary care setting reduces prescribed antihypertensive medications. Blood Press Monit. 2023; 28(6):338-342. DOI: 10.1097/MBP.0000000000000673. View

15.

Calvi A, Fischetti I, Verzicco I, Belvederi Murri M, Zanetidou S, Volpi R . Antidepressant Drugs Effects on Blood Pressure. Front Cardiovasc Med. 2021; 8:704281. PMC: 8370473. DOI: 10.3389/fcvm.2021.704281. View

16.

Eigenbrodt M, Rose K, Couper D, Arnett D, Smith R, Jones D . Orthostatic hypotension as a risk factor for stroke: the atherosclerosis risk in communities (ARIC) study, 1987-1996. Stroke. 2000; 31(10):2307-13. DOI: 10.1161/01.str.31.10.2307. View

17.

Rose K, Tyroler H, Nardo C, Arnett D, Light K, Rosamond W . Orthostatic hypotension and the incidence of coronary heart disease: the Atherosclerosis Risk in Communities study. Am J Hypertens. 2000; 13(6 Pt 1):571-8. DOI: 10.1016/s0895-7061(99)00257-5. View

18.

Unger T, Borghi C, Charchar F, Khan N, Poulter N, Prabhakaran D . 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens. 2020; 38(6):982-1004. DOI: 10.1097/HJH.0000000000002453. View

19.

Finucane C, OConnell M, Donoghue O, Richardson K, Savva G, Kenny R . Impaired Orthostatic Blood Pressure Recovery Is Associated with Unexplained and Injurious Falls. J Am Geriatr Soc. 2017; 65(3):474-482. DOI: 10.1111/jgs.14563. View

20.

Poon I, Braun U . High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther. 2005; 30(2):173-8. DOI: 10.1111/j.1365-2710.2005.00629.x. View