ORTHOSTATIC HYPOTENSION WITH SYNCOPE - A PROBLEM OF ANTIHYPERTENSIVE TREATMENT IN THE ELDERLY

In 12 of 32 elderly (> 65 years) hypertensives admitted with syncope, a diagnosis of orthostatic hypotension was made after a positive ortho static tolerance test and extensive diagnostic evaluation with exclusi on of other causes of syncope. Blood pressure of these 12 patients (pt s.) after admission was 145 +/- 16/83 +/- 6 mm Hg; at that time the pt s. were treated with 2.6 +/- 1.6 different antihypertensive agents, an d 67 % of the pts. received a combination therapy. After reevaluation of treatment the pts. could be discharged with 1.3 +/- 0.7 different a ntihypertensive agents (significant difference, p < 0.02); in 25 % of pts. (p < 0.05) combination therapy was still necessary. Before discha rge casual blood pressure was 156 +/- 17/85 +/- 5 mm Hg (with the pati ent in the sitting position); average daytime ambulatory blood pressur e was 145 +/- 18/80 +/- mm Hg. Three months after discharge 91 % of pt s. remained free of a new syncope. Orthostatic hypotension is a freque nt cause of syncope in the hypertensive elderly; thus, their blood pre ssure should be checked more often in the sitting and standing positio n and by ambulatory monitoring.