SYMPTOMATIC ORTHOSTATIC HYPOTENSION DUE TO OVERTREATMENT OF HYPERTENSION IN THE ELDERLY

In 14 elderly (>65 years) hypertensives, admitted with syncope, collapse or transient ischemic attack, a diagnosis of orthostatic hypotension was made after a positive standardized orthostatic tolerance test and extensive diagnostic evaluation. Blood pressure after admission, while the patients were taking 2.6 +/- 1.6 different antihypertensive agents, was 145 +/- 22/82 +/- 8 mm Hg. 64% of the patients were treated with a combination therapy. After reevaluation of treatment the patients could be discharged with 1,3 +/- 0.7 different drugs (significant difference, p < 0.02), 10 patients with monotherapy. Casual blood pressure was 156 +/- 17/85 +/- 5 mm Hg in a sitting position and average daytime ambulatory blood pressure was 148 +/- 16/82 +/- 7 mm Hg. 3 months after discharge 86% of the patients were free of new symptomatic orthostatic hypotension. Orthostatic hypotension appears frequently in elderly treated hypertensives. Thus blood pressure should be checked in a sitting and standing position and if necessary by ambulatory blood pressure monitoring to avoid overtreatment.