Pressor effects of beta-blockers on standing blood pressure may be harmful for older patients with orthostatic hypertension.

Abstract

To the Editor: Cleophas et al1 reported an interesting pressor effect of β-blockers in elderly patients with mild hypertension on standing such that pulse pressure, which decreased on standing when treated, showed an increase after β-blockade. Although they considered this pressor effect to be beneficial, we think that this is not always the case. The orthostatic blood pressure (BP) reaction varies greatly among older individuals. In addition to orthostatic hypotension, which is a well-known risk factor for falls, syncope, and cardiovascular events in the elderly,2 in a recent study,3 we found orthostatic hypertension to be a new risk factor for stroke in elderly hypertensive patients. We performed a head-up tilt test and brain MRI in 241 elderly subjects with sustained hypertension confirmed by ambulatory BP monitoring. We classified the patients into an orthostatic hypertension group with an orthostatic increase of systolic BP (SBP) of ≥20 mm Hg (n=26), an orthostatic hypotension group with an orthostatic SBP decrease of ≥20 mm Hg (n=23), and a normal …