Orthostatic hypotension in the elderly and its association with the antihypertensive treatment

BACKGROUND: TO assess the prevalence of orthostatic hypotension (OH) in an elderly population and to evaluate the influence of hypertension control an d of the type of antihypertensive drug used. METHODS: 2,700 elderly patients (> 65 years) from the EPICARDIAN study were included. Blood pressure (BP) was measured twice with the patient seated a nd once again 1 to 3 minutes afterwards with the patient standing. Hyperten sion is defined as BP greater than or equal to 140/90 mmHg or if the patien t received antihypertensive treatment. Orthostatic hypotension was defined as a fall of SEP greater than or equal to 20 mmHg and/or DBP greater than o r equal to 10 mmHg 1 to 3 minutes after the postural change. RESULTS: 71.6% of the patients were classified as hypertensive and 57.1% we re receiving pharmacological treatment. The overall prevalence of OH was 6. 8% among hypertensive patients, 8.1% and 3.4% in normotensives patients (p < 0.05). No significant difference was found in the prevalence of OH betwee n those receiving (7.7%) or not (8.6%) antihypertensive medication. No asso ciation was found either between the prevalence of OH and the type or numbe r of antihypertensive drugs used. 17.6% of the patients reached hypertensio n optimal control (SBP < 140 and DBP < 90 mmHg), the prevalence of OH in th ese patients was 5.3%, among the uncontrolled the prevalence was 8.9% (p < 0.05). The adjusted OR was 1.91 (1.1-3.3) for the prevalence of OH in the u ncontrolled patients versus the controlled. CONCLUSIONS: The prevalence of OH in the elderly is not very high, being gr eater among hipertensive than normotensive patients. No association was fou nd between the prevalence of OH and the number of drugs received. Reaching hypertension control reduces the prevalence of OH.