Drug-induced Orthostatic Hypotension in the Elderly: Avoiding Its Onset

Overview

Journal Drug Saf

Specialties Pharmacology
Toxicology

Date 1997 Aug 1

PMID 9285201

Citations 22

Authors

I Verhaeverbeke

T Mets

Affiliations

Soon will be listed here.

Abstract

The prevalence of orthostatic hypotension in the elderly is reported to be 5 to 33%. This high prevalence contributes to the risk of syncope and falls in old age. Drugs are a major cause of postural hypotension. Changes in pharmacokinetics and pharmacodynamics occur with aging in relation to many drugs, resulting in delayed elimination and increased bioavailability. Therefore, drugs with an antihypertensive action (diuretics, calcium antagonists, beta-blockers, ACE inhibitors, alpha 1-blockers, and centrally acting antihypertensives) have a more pronounced effect in the elderly. Nitrates, antiparkinsonian drugs, antidepressants and antipsychotics all cause hypotension as a known adverse effect. When assessing orthostatic hypotension in the elderly, drug treatment should always be reviewed. Whenever possible, antihypertensive drugs should be discontinued, and the dosages of essential drugs should be reduced.

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References

Morrison R, Singhvi S, Peterson A, Pocetti D, Migdalof B . Relative contribution of the gut, liver, and lung to the first-pass hydrolysis (bioactivation) of orally administered 14C-fosinopril sodium in dogs. In vivo and in vitro studies. Drug Metab Dispos. 1990; 18(2):253-7. View

Walker J, Wynne H . Review: the frequency and severity of adverse drug reactions in elderly people. Age Ageing. 1994; 23(3):255-9. DOI: 10.1093/ageing/23.3.255. View

Giudicelli J, Berdeaux A, Edouard A, Richer C, Jacolot D . The effect of enalapril on baroreceptor mediated reflex function in normotensive subjects. Br J Clin Pharmacol. 1985; 20(3):211-8. PMC: 1400702. DOI: 10.1111/j.1365-2125.1985.tb05063.x. View

Lipsitz L . Orthostatic hypotension in the elderly. N Engl J Med. 1989; 321(14):952-7. DOI: 10.1056/NEJM198910053211407. View

Marchionni N, Schneeweiss A, Di Bari M, Ferrucci L, Moschi G, Salani B . Age-related hemodynamic effects of intravenous nitroglycerin for acute myocardial infarction and left ventricular failure. Am J Cardiol. 1988; 61(9):81E-83E. DOI: 10.1016/0002-9149(88)90096-3. View

Tinetti M, Speechley M . Prevention of falls among the elderly. N Engl J Med. 1989; 320(16):1055-9. DOI: 10.1056/NEJM198904203201606. View

Mets T . Drug-induced orthostatic hypotension in older patients. Drugs Aging. 1995; 6(3):219-28. DOI: 10.2165/00002512-199506030-00005. View

Opie L . Profiles of calcium antagonists in cardiovascular disease with special reference to second-generation agents and amlodipine. Postgrad Med J. 1991; 67 Suppl 5:S2-8. View

Mets T, De Bock V, Praet J . First-dose hypotension, ACE inhibitors, and heart failure in the elderly. Lancet. 1992; 339(8807):1487. DOI: 10.1016/0140-6736(92)92090-3. View

10.

Kelly J, OMalley K . Nitrates in the elderly. Pharmacological considerations. Drugs Aging. 1992; 2(1):14-9. DOI: 10.2165/00002512-199202010-00003. View

11.

MENDELS J . Clinical management of the depressed geriatric patient: current therapeutic options. Am J Med. 1993; 94(5A):13S-18S. View

12.

Robertson D, Goldberg M, Hollister A, Wade D, Robertson R . Clonidine raises blood pressure in severe idiopathic orthostatic hypotension. Am J Med. 1983; 74(2):193-200. DOI: 10.1016/0002-9343(83)90607-1. View

13.

Deget F, Brogden R . Cilazapril. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in cardiovascular disease. Drugs. 1991; 41(5):799-820. DOI: 10.2165/00003495-199141050-00008. View

14.

Krum H, Conway E, Broadbear J, Howes L, Louis W . Postural hypotension in elderly patients given carvedilol. BMJ. 1994; 309(6957):775-6. PMC: 2541042. DOI: 10.1136/bmj.309.6957.775. View

15.

Robertson D, Wood N, Everest H, Monks K, Waller D, Renwick A . The effect of age on the pharmacokinetics of levodopa administered alone and in the presence of carbidopa. Br J Clin Pharmacol. 1989; 28(1):61-9. PMC: 1379971. DOI: 10.1111/j.1365-2125.1989.tb03506.x. View

16.

Studer J, Piepho R . Antihypertensive therapy in the geriatric patient: II. A review of the alpha1-adrenergic blocking agents. J Clin Pharmacol. 1993; 33(1):2-13. DOI: 10.1002/j.1552-4604.1993.tb03896.x. View

17.

Staessen J, Celis H, Thijs L, Fagard R, Amery A . Once-daily antihypertensive treatment with calcium antagonists: utopia or reality?. Neth J Med. 1995; 46(1):15-24. DOI: 10.1016/0300-2977(94)00083-l. View

18.

Raiha I, Luutonen S, Piha J, Seppanen A, Toikka T, SOURANDER L . Prevalence, predisposing factors, and prognostic importance of postural hypotension. Arch Intern Med. 1995; 155(9):930-5. DOI: 10.1001/archinte.1995.00430090067008. View

19.

Robertson D, Waller D, Renwick A, George C . Age-related changes in the pharmacokinetics and pharmacodynamics of nifedipine. Br J Clin Pharmacol. 1988; 25(3):297-305. PMC: 1386353. DOI: 10.1111/j.1365-2125.1988.tb03307.x. View

20.

Preskorn S . Recent pharmacologic advances in antidepressant therapy for the elderly. Am J Med. 1993; 94(5A):2S-12S. View