Abstract
Abstract Background Fludrocortisone is frequently used to raise blood pressure in older patients with falls due to hypotension, yet evidence to support its use is limited. The aim of this study was to assess changes in Ambulatory Blood Pressure Monitors (ABPM) markers of future falls risk seen after commencing/increasing Fludrocortisone in older people with falls due to orthostatic hypotension (OH) or vasovagal syncope. Methods A cohort of older patients (≥65 years) attending a tertiary-referral falls & syncope unit and prescribed Fludrocortisone were included. ABPM at index visit and follow-up (after commencing/increasing Fludrocortisone) were analysed, with specific focus on markers of future falls risk: overall Systolic Blood Pressure (sBP), minimum sBP, sBP variability & ‘dips’ in systolic sBP <100 mm Hg. These variables were compared pre and post Fludrocortisone using paired t-tests. Results Twenty-three patients (median age 74 years (SD 6.05), 3/4 with OH) were followed for median 4.5 (SD 6.53) months. Two-thirds were commenced on Fludrocortisone, with the dose increased in the rest. Patients commencing Fludrocortisone had a significant increase in overall sBP from 110.13mmHg (95% CI 104.26 – 116.00) to 127.93mmHg (95% CI 120.00 – 135.87) (p<0.001) at follow-up, and a significant increase in minimum sBP from 82.2mmHg (95% CI 76.25 – 88.15) to 99.87mmHg (95% CI 91.47 – 108.26) (p=0.001). There was also a significant reduction in the number of SBP ‘dips’ after commencing Fludrocortisone (9.6 pre to 2.67 post, (95% CI 0.08 – 5.25), p=0.004)), and after commencing/increasing Fludrocortisone dose (8.09 pre to 2.74 post (95% CI 0.62 – 4.85) (p=0.012)). Conclusion This study provides clinical data on the effectiveness of Fludrocortisone in older patients with falls due to hypotension, demonstrating significantly improved markers of future falls risk. Overall sBP increased significantly by 16% and minimum sBP increased by over 20% after starting Fludrocortisone. The number of SBP ‘dips’ also significantly reduced, by over 70% in those who commenced Fludrocortisone.
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