Is Postural Hypotension a Real Problem with Antihypertensive Medication? (original) (raw)
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Review Articles| November 08 2001
University of Glasgow, Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK
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Cardiology (2001) 96 (Suppl. 1): 19–24.
Abstract
Historically, postural hypotension has been cited as a consideration which might influence the selection of antihypertensive therapy. The common symptoms (dizziness, blackouts, syncope) give cause for concern but they are not attributed to every class of antihypertensive drug. For example, administration of a β-blocker is not generally associated with symptomatic postural hypotension, whereas the α-blocker prazosin was particularly problematical, with a significant and well-recognized risk of first-dose postural effects. Titration from a low starting dose and careful selection/monitoring of patients have been successfully used to circumvent this problem. However, since there is a relatively high incidence of postural hypotensive symptoms in elderly patients in general, it may be a misconception to attribute such symptoms to any particular type of antihypertensive drug. Furthermore, with the newer α1-blockers, such as doxazosin, which have a more gradual onset of action, there is a markedly reduced tendency for postural hypotension to occur. Thus, it is perhaps time to reassess the real significance of iatrogenic postural hypotension in the selection of antihypertensive therapy.
References
Mader SL: Aging and postural hypotension. An update. J Am Geriatr Soc 1989;37:129–137.
Lipsitz LA: Orthostatic hypotension in the elderly. New Eng J Med 1989;321:952–957.
Ensrud KE, Nevitt MC, Yunis C, Hulley SB, Grimm RH, Cummings SR: Postural hypotension and postural dizziness in elderly women. The study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group. Arch Intern Med 1992;152:1058–1064.
Shaw FE, Kenny RA: The overlap between syncope and falls in the elderly. Postgrad Med J 1997;73:635–639.
Mader SL, Josephson KR, Rubenstein LZ: Low prevalence of postural hypotension among community-dwelling elderly. JAMA 1987;258:1511–1514.
Myers MG, Kearns PM, Kennedy DS, Fisher RH: Postural hypotension and diuretic therapy in the elderly. Can Med Assoc J 1978;119:581–584.
Strogatz DS, Keenan NL, Barnett EM, Wagner EH: Correlates of postural hypertension in a community sample of elderly blacks and whites. J Am Geriatr Soc 1991;39:562–566.
Räihä I, Luutonen S, Piha J, Seppänen A, Toikka T, Sourander L: Prevalence, predisposing factors, and prognostic importance of postural hypotension. Arch Intern Med 1995;155:930–935.
Tilvis RS, Hakala SM, Valvanne J, Erkinjuntti T: Postural hypotension and dizziness in a general aged population: A 4-year follow-up of the Helsinki Aging Study. J Am Geriatr Soc 1996;44:809–814.
Landsberg L: Unique problems in the treatment of the older hypertensive male. Introduction: Increased sympathetic nervous system activity in the elderly. Br J Clin Pract 1994;74(suppl):1–3.
Harris T, Lipitz LA, Kleinman JC, Carnoni-Huntley J: Postural changes in blood pressure associated with age and systolic blood pressure. The National Health and Nutrition Examination Survey II. J Gerontol 1991;46:159–163.
Zachariah PK, Krier J, Schwartz GL: Orthostatic hypotension and ambulatory blood pressure monitoring. J Hypertens 1991;9:S78–S80.
Fotherby MD, Robinson TG, Potter JF: Clinic and 24-hour blood pressure in elderly treated hypertensives with postural hypotension. J Hum Hypertens 1994;8:711–716.
Luutonen S, Neuvonen P, Ruskoaho H, Räihä I, Rajala T, Antita K, Sourander L: The role of potassium in postural hypotension: Electrolytes and neurohumoral factors in elderly hypertensive patients using diuretics. J Int Med 1995;237:375–380.
Cox JR, Admani AK, Agarwal ML, Abel P: Postural hypotension: Body fluid compartments and electrolytes. Age Ageing 1972;2:112–120.
Heseltine D, Thomas TH, James OFW, Potter JF: Erythrocyte potassium alterations in elderly subjects with postural hypertension. J Clin Exp Gerontol 1990;12:125–136.
Elliott HL, McLean K, Sumner DJ, Meredith PA, Reid JL: Immediate cardiovascular responses to oral prazosin – effects of concurrent beta-blockers. Clin Pharmacol Ther 1981;29:303–309.
Hodsman GP, Isles CG, Murray GD, Usherwood TP, Webb DJ, Robertson JIS: Factors related to first-dose hypotensive effect of captopril: Prediction and treatment. Br Med J 1983;286:832–834.
Postma CT, Dennessen PJW, de Boo T, Thien T: First-dose hypotension after captopril; can it be predicted? A study of 240 patients. J Hum Hypertens 1992;6:205–209.
Turner AS, Watson OF, Brocklehurst JE: Prazosin in hypertension. Part II. Effects of the initial dose. NZ Med J 1977;86:286–289.
Stokes GS, Graham RM, Gain JM, Davis PR: Influence of dosage and dietary sodium on the first-dose effects of prazosin. Br Med J 1977;1:1507–1508.
Sumner DJ, Meredith PA, Howie CA, Elliott HL: Initial blood pressure as a predictor of the response to antihypertensive therapy. Br J Clin Pharmac 1988;26:715–720.
Fulton B, Wagstaff AJ, Sorkin EM: Doxazosin: An update of its clinical pharmacology and therapeutic applications in hypertension and benign prostatic hyperplasia. Drugs 1995;49:295–320.
Chung M, Vashi V, Puente J, Sweeney M, Meredith P: Clinical pharmacokinetics of doxazosin in a controlled-release gastrointestinal therapeutic system (GITS) formulation. Brit J Clin Pharmacol 1999;48:678–687.
Gotzen R: Vorteile der neuen Formulierung Doxazosin PP in der antihypertensiven Therapie: Orthostase – Toleranz im Vergleich zum herkömmlichen Doxazosin. Perfusion 1998;11:485–492.
Heseltine D, Bramble MG: Loop diuretics cause less postural hypotension than thiazide diuretics in the frail elderly. Curr Med Res Opin 1988;11:232–235.
Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA: Evaluation of investigations to diagnose the cause of dizziness in elderly people: A community-based controlled study. Br Med J 1996;313:788–792.
Itskovitz HD: Alpha 1-blockade for the treatment of hypertension: A megastudy of terazosin in 2,214 clinical practice settings. Clin Ther 1994;16:490–504.
Maslowski AH: Clinical experience with doxazosin in general medical practice in New Zealand. Am Heart J 1991;121:323–328.
Langdon CG, Packard RS: Doxazosin in hypertension: Results of a general practice study in 4,809 patients. Br J Clin Pract 1994;48:293–298.
Neaton JD, Grimm RH Jr, Prineas RJ, Stamler J, Grandits GA, Elmer PJ, Cutler JA, Flack JM, Schoenberger JA, McDonald R, Lewis CE, Liebson PR: Treatment of Mild Hypertension Study. Final results. JAMA 1993;270:713–724.
Svetkey LP, Brobyn R, Deedwania P, Graham RM, Morganroth J, Klotman PE: Double-blind comparison of doxazosin, nadolol, and placebo in patients with mild-to-moderate hypertension. Curr Ther Res 1988;43:969–978.
Fallowfield JM, Blenkinsopp J, Raza A, Fowkes AG, Higgins TJC, Bridgman KM: Post-marketing surveillance of lisinopril in general practice in the UK. Br J Clin Pharmac 1993;47:296–304.
Nomura A, Kakinoki S, Sakurai M, Hirabayashi T, Nakamura M, Yoneya K, Imamura K, Kitabatake A: Effects of doxazosin on orthostatic blood pressure in hypertensive patients with and without diabetes mellitus. Curr Ther Res 1996;57:411–417.
Graham RM, Thornell IR, Gain JM, Bagnoli C, Oates HF, Stokes GS: Prazosin: The first-dose phenomenon. Br Med J 1976;2:1293–1294.
The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993;153:154–183.
© 2001 S. Karger AG, Basel
2001
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