CLINIC AND 24H BLOOD-PRESSURE IN ELDERLY TREATED HYPERTENSIVES WITH POSTURAL HYPOTENSION

The objectives of this study were to determine the prevalence of, and factors associated with, postural hypotension (PH) in elderly treated hypertensive subjects, to examine the 24h BP profile in those subjects with and without PH and to determine the effects of antihypertensive treatment withdrawal on the prevalence and symptoms of PH. Eighty-six subjects (mean age +/- standard deviation 76 +/- 6 years) on antihyper tensive drug therapy for > 6 months had three clinic BP measurements t aken in supine and standing positions followed by 24h ambulatory BP mo nitoring. Forty-seven subjects underwent repeat BP measurement five we eks after withdrawal of antihypertensive medication and institution of standard nonpharmacological methods. Twenty-six (30%) of the 86 subje cts exhibited PH (defined as SBP fall on standing greater-than-or-equa l-to 20 mmHg) within three minutes of standing. Supine clinic and 24h SBP and DBP, age and presence of previous cardiovascular events were s imilar in the groups with and without PH. There was a significant corr elation between the orthostatic BP fall for all subjects and day-night SBP difference (r = -0.30, P = 0.01) and urinary sodium:creatinine ra tio (r = -0.33, P = 0.04). Multiple regression analysis revealed only the day-night SBP difference was a significant predictor of orthostati c BP change. In the PH group, 19 subjects had treatment withdrawn resu lting in a reduction of 58% (P > 0.001) in those continuing to demonst rate PH. If indicated a trial of antihypertensive drug treatment withd rawal could reduce the risk of PH; the additional benefit of instituti ng nonpharmacological therapy in reducing BP and orthostatic hypotensi on warrants further assessment.