Orthostatic Hypotension In Older People Research Articles

Drug-induced orthostatic hypotension: Cluster analysis of co-prescription patterns in older people in UK primary care.

Over 250 medications are reported to cause orthostatic hypotension, associated with serious adverse outcomes in older adults. Studies suggest a harmful cumulative risk of orthostatic hypotension with multiple medication use. However, there is limited evidence on the potential for harm in practice, particularly which drugs is co-prescribed and may increase risk of orthostatic hypotension. Retrospective cohort study and cluster analysis using general practice data from IQVIA Medical Research Data (IMRD) in patients aged ≥50 contributing data between 1 January 2018 and 31 December 2018. Thirteen drug groups known to be associated with orthostatic hypotension by mechanism, were analyzed and clusters generated by sex and age-band. A total of 602 713 individuals aged ≥50 with 283 912 (47%) men and 318 801 (53%) women were included. The most prevalent prescriptions that might contribute to orthostatic hypotension were ACE inhibitors, calcium-channel blockers, beta-blockers, selective serotonin reuptake inhibitors and uroselective alpha-blockers. We identified distinct clusters of cardiovascular system (cardiovascular system) drugs in men and women at all ages. cardiovascular system plus psychoactive drug clusters were common in women at all ages, and in men aged ≤70. cardiovascular system plus uroselective alpha-blockers were identified in men aged ≥70. Distinct clusters of drugs associated with orthostatic hypotension exist in practice, which change over the life course. Our findings highlight potentially harmful drug combinations that may cause cumulative risk of orthostatic hypotension in older people. This may guide clinicians about the potential of synergistic harm and to monitor for orthostatic hypotension if using combinations of cardiovascular system drugs, cardiovascular system plus psychoactive drugs and/or alpha-blockers-particularly in patients aged ≥70 or at high-risk due to comorbidity. Future research should consider quantifying the risk of drug-induced orthostatic hypotension with such drug combinations.

Diagnosis of orthostatic hypotension in older people

Orthostatic hypotension (OH) can be classified to classic OH, delayed OH, initial OH, and delayed blood pressure recovery. It causes various symptoms such as lightheadedness, dizziness, visual blurring, and fall. Furthermore, the importance of OH is emphasized because it increases morbidity and mortality, especially in the elderly. Because neurogenic and non-neurologic components cause OH, an appropriate diagnosis is required to differentiate it.

Strategies to improve uptake and adherence of non-pharmacologic interventions for orthostatic hypotension in older people: a qualitative study

Key Summary PointsAimTo identify specific behavioural change techniques to promote uptake and adherence with non-pharmacologic interventions for older adults with OH.FindingsSpecific behaviour change strategies, derived from older people with orthostatic hypotension, include biofeedback, rehearsal, embedding into daily routine and patient education.MessageEvidence-based behaviour change strategies may be used to improve uptake and adherence to non-drug therapies for older people with orthostatic hypotension.

Combination non-pharmacologic intervention for orthostatic hypotension in older people: a phase 2 study

Backgroundorthostatic hypotension (OH) is highly prevalent in older populations and is associated with reduced quality of life and increased mortality. Although non-pharmacologic therapies are recommended first-line, evidence for their use is lacking.Objectivedetermine the efficacy of combination non-pharmacologic therapy for OH in older people.Methodsa total of 111 orthostatic BP responses were evaluated in this prospective phase 2 efficacy study in 37 older people (≥60 years) with OH. Primary outcome was the proportion of participants whose systolic BP drop improved by ≥10 mmHg. Secondary outcomes include standing BP and symptoms. Comparison is made to the response rate of the most efficacious single therapy (bolus water drinking 56%). Therapeutic combinations were composed of interventions with known efficacy and tolerability: Therapy A- Bolus water drinking + physical counter-manoeuvres (PCM); Therapy B- Bolus water drinking + PCM + abdominal compression.Resultsthe response rate to therapy A was 38% (95% confidence interval – CI 24, 63), with standing systolic BP increasing by 13 mmHg (95% CI 4, 22). Therapy B was efficacious in 46% (95% CI 31, 62), increasing standing systolic BP by 20 mmHg (95% CI 12, 29). Neither therapy had a significant effect on symptoms. There were no adverse events.Conclusionsin comparison to single therapy, there is little additional benefit to be gained from combination non-pharmacologic therapy. Focussing on single, efficacious therapies, such as bolus water drinking or PCM, should become standard first-line therapy.

19 The Efficacy, Safety and Acceptability of Non-Pharmacologic Therapy for Orthostatic Hypotension in Older People: A Mixed Methods Study

Abstract Introduction First-line treatment for OH is typically with non-pharmacologic therapy. However, the current evidence base is poor, particularly in older people. Aim Determine the safety, efficacy and acceptability of single and combination therapies for OH in older people. Methods A three-stage, mixed-methods study consisting of a phase 2 efficacy study with a nested qualitative study. Stage One calculated response rates to therapy (defined as an improvement in standing systolic blood pressure (SSBP) by ≥10 mmHg). Stage Two explored the tolerability of therapies in qualitative interviews. Stage Three evaluated response rates to combinations of the most efficacious and tolerable therapies. All participants were aged ≥60 years, had OH and were recruited from a UK Falls and Syncope Service. Results Stage One. Response rates to therapies were evaluated in 25 older people (74 years, 60-92): Bolus-water drinking 56% (95%CI 35, 76); abdominal compression 52% (95%CI 31, 72), physical counter-maneuvers 44% (PCM, 95%CI 24, 65), full-leg length compression 32% (95%CI 15, 54). Stage Two. PCM was considered an acceptable therapy as no equipment is required, is only needed during postural change and can be performed conspicuously. Water was largely acceptable but there were concerns around urinary frequency. Compression stockings were considered unacceptable due to cosmesis, practicalities and discomfort. There were mixed views on the tolerability of abdominal compression. There were no adverse events. Stage Three. Response rates to combination therapy were evaluated in 37 older people (71 years, 60-94). Bolus water drinking + PCM 38% (95%CI 22, 55); water + PCM + abdominal compression 46% (95%CI 29, 63). Conclusions Due to its superior efficacy, safety and acceptability, bolus water drinking should become standard first-line therapy. Conversely, compression stockings should be disregarded in this population, as they are the least efficacious and most unacceptable treatment. Surprisingly, there is no additional benefit of combining therapies.

Review of management strategies for orthostatic hypotension in older people

AbstractOrthostatic hypotension (OH) is common in older people and is associated with a range of adverse outcomes. Although age‐related changes like decreased baroreflex sensitivity make older people prone to OH, medications are often a contributor. Diagnosis of OH can be challenging in older people, because the condition may present with atypical or non‐specific symptoms, such as visual disturbances, shortness of breath, mental fluctuation. Non‐pharmacological management is often a starting point for OH treatment. Fludrocortisone and midodrine remain the most studied drugs for pharmacological management, but newer agents are being tested. In this review we present the current evidence for existing and emerging treatments for OH and address the management of supine hypertension associated with the treatment of OH in patients with autonomic failure. In the management of OH, it is imperative that treatment is tailored to the individual, rather than focusing on attaining an arbitrary blood pressure target.

The association between antidepressant use and orthostatic hypotension in older people: a matched cohort study

Orthostatic hypotension (OH) is often reported as a significant potential adverse effect of antidepressant use but the association between phasic blood pressure (BP) and antidepressants has not yet been investigated. This cross-sectional study compares continuously measured phasic BP and prevalence of OH in a cohort of antidepressant users ≥50 years compared with an age- and sex-matched cohort not taking antidepressants. OH was defined as a drop in systolic BP ≥ 20 mm Hg or in diastolic BP ≥ 10 mm Hg at 30 seconds after standing, measured using continuous beat-to-beat finometry. Multilevel time × group interactions revealed significantly greater systolic and diastolic BP drop in antidepressant users than nonusers at 30 seconds after stand. The prevalence of OH among antidepressant users was 31% (63/206), compared with 17% in nonusers (X2 = 9.7; P = .002). Unadjusted logistic regression models demonstrated that selective serotonin reuptake inhibitor use was associated with OH at an odds ratio of 2.11 (95% confidence interval: 1.25–3.57); P = .005, and this association was not attenuated when covariates including cardiac disease and depressive symptom burden were added. There was no statistically significant association between serotonin noradrenaline reuptake inhibitor or tricyclic antidepressant use and OH in unadjusted models although the study was not powered to detect changes within these subgroups. Older people taking antidepressants have a two-fold higher prevalence of OH than nonusers, highlighting the importance of screening the older antidepressant user for OH and dizziness and rationalizing medications to reduce the risk of falls within this vulnerable cohort.

Orthostatic hypotension in older persons is not associated with cognitive functioning, features of cerebral damage or cerebral blood flow

Particularly in old age, orthostatic hypotension has been related to worse cognitive functioning, possibly caused by reduced cerebral blood flow (CBF). This study investigates whether orthostatic hypotension in older people is associated with cognitive dysfunction and, if so, whether this association is mediated by cerebral vascular damage and/or decreased CBF. Four hundred and twenty participants of the Discontinuation of ANtihypertensive Treatment in Elderly People (DANTE) Study Leiden (mean age 81 years, all using antihypertensive medication and with mild cognitive deficits), and MRI data from 214 participants of the nested DANTE MRI sub-study. Orthostatic hypotension was defined as either a SBP decrease at least 20 mmHg and/or a DBP decrease of at least 10 mmHg within 3 min of standing up. Cognitive functioning was assessed using a battery of six cognitive tests covering global cognition, memory function, executive function and psychomotor speed. Cerebral vascular damage and CBF were assessed using MRI. The prevalence of orthostatic hypotension was 47% (n = 199). Compared with the group without orthostatic hypotension, participants with orthostatic hypotension showed no differences in any of the cognitive functions, features of cerebral small vessel disease, microstructural integrity or CBF. In this population of older persons, the presence of orthostatic hypotension was not associated with decreased cognition. In addition, no differences were found in the supposedly underlying cerebral vascular mechanisms.

Serum 25-hydroxyvitamin D and orthostatic hypotension in old people: the Pro.V.A. study.

Interest in the association between serum 25-hydroxyvitamin D (25OHD) and blood pressure has increased because recent research showed a close relationship between them, but there is still little information on the possible association between 25OHD and orthostatic hypotension. The aim of this study was to explore the relationship of 25OHD levels with any presence of orthostatic hypotension in a large group of older people. This study was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study involving people aged >65 years. In this cross-sectional work, we considered 2640 (1081 men and 1559 women) with a mean age of 73.8±6.8 years. Orthostatic hypotension was defined as a drop of ≤20 mm Hg in systolic or ≤10 mm Hg in diastolic blood pressure <3 minutes of orthostatism. Orthostatic hypotension was identified in 32.2% of the sample. The prevalence of orthostatic hypotension was higher in individuals with 25OHD levels <50 nmol/L, but this trend was not significant (P=0.13). Individuals who had orthostatic hypotension had significantly lower 25OHD levels than those who did not (75.0±51.4 versus 82.6±54.0 nmol/L; P<0.0001). On logistic regression analysis, the greater likelihood of individuals with lower 25OHD levels having orthostatic hypotension was no longer statistically significant after adjusting for potential confounders (odds ratio, 1.08; 95% confidence interval, 0.77-1.51; P=0.67 for people with 25OHD levels ≤25 nmol/L; odds ratio, 1.01; 95% confidence interval, 0.78-1.32; P=0.92 for those with 25OHD levels between 25 and 50 nmol/L). In conclusion, vitamin D is not significantly associated with any orthostatic hypotension in older people.

O1.18: Exercise for orthostatic hypotension in older people

O1.18: Exercise for orthostatic hypotension in older people

Orthostatic hypotension in older people

To enhance awareness of orthostatic hypotension (OH) in older populations, and guide primary care nurse practitioners (NPs) in the assessment and management of patients with OH. Electronic data collection was conducted on studies and reviews that were published between 2005 and 2012 in English, and contained information related to the purpose of this article from following databases: PubMed, Scopus, and MEDLINE. OH is a syndrome that is accompanied by unfavorable symptoms such as dizziness, and headaches and can impede the individual's daily activities and quality of life. The prevalence of OH is higher in older people because of comorbidities, polypharmacy, and physiological changes that occur with aging. OH is diagnosed with serial blood pressure measurements and the primary goal of management is to relieve unfavorable symptoms and enhance patient safety. Pharmacological management is considered when nonpharmacological interventions fail. OH is not a problem to be taken lightly as it is highly related to the risk of falling and cardiovascular problems, as well as increasing morbidity and mortality rates. NPs can contribute to improving the quality of life for older adults and reducing adverse consequences by understanding OH and adequately managing it.

Assessing orthostatic hypotension in older people

Assessing orthostatic hypotension in older people