Is postural hypotension a real problem with antihypertensive medication?

Historically, postural hypotension has been cited as a consideration which might influence the selection of anti hypertensive therapy. The common symp toms (dizziness, blackouts, syncope) give cause for concern but they are no t attributed to every class of anti hypertensive drug. For example, adminis tration of a beta -blocker is not generally associated with symptomatic pos tural hypotension, whereas the alpha -blocker prazosin was particularly pro blematical, with a significant and well-recognized risk of first-dose postu ral effects. Titration from a low starting dose and careful selection/monit oring of patients have been successfully used to circumvent this problem. H owever, since there is a relatively high incidence of postural hypotensive symptoms in elderly patients in general, it may be a misconception to attri bute such symptoms to any particular type of anti hypertensive drug. Furthe rmore, with the newer alpha (1)-blockers, such as doxazosin, which have a m ore gradual onset of action, there is a markedly reduced tendency for postu ral hypotension to occur. Thus, it is perhaps time to reassess the real sig nificance of iatrogenic postural hypotension in the selection of antihypert ensive therapy. Copyright (C) 2001 S. Karger AG, Basel.