Abstract P160: Orthostatic Hypotension During Hospitalization: A Retrospective Observational Study

Abstract

Background: During hospital admissions, orthostatic hypotension (OH) is often considered a consequence of hypertension treatment, but the impact of reducing antihypertensive agents on OH response is unknown. Objective: To examine the association between inpatient antihypertensive medication changes and OH response. Methods: In this retrospective observational study, we reviewed electronic medical records of adult patients who experienced OH during their admission to Beth Israel Deaconess Medical Center between 2015 and 2021. Antihypertensive classes were categorized as not prescribed, no change, or decrease. OH improvement was assessed using vital sign flow sheets at presentation and discharge. We used logistic regression models adjusted for age, sex, and Black race to assess the association between antihypertensive categories and OH improvement. Results: Among 399 included patients (mean age: 69.9 years, 44% female, 10% Black), beta blockers (45%) were the most common antihypertensive class prescribed, followed by loop diuretics (23%), alpha blockers (21%), ACE inhibitors (20%), dihydropyridines (16%), ARBs (12%), thiazide diuretics (10%), and non-dihydropyridines (4%). Not being prescribed a dihydropyridine was associated with OH improvement (OR =2.37, 95% CI: 1.16-4.84), while decreasing a loop diuretic was associated with OH improvement (OR = 3.49, 95% CI: 1.46-8.36) (Table) . Changes to other classes were not associated with OH improvement. Conclusion: This study suggests that neither continuation nor reduction of most antihypertensives is associated with OH improvement. These findings should be tested in a prospective randomized trial.