[Orthostatic hypotension with syncope--a problem of hypertensive therapy in the aged]

In 12 of 32 elderly (> 65 years) hypertensives admitted with syncope, a diagnosis of orthostatic hypotension was made after a positive orthostatic tolerance test and extensive diagnostic evaluation with exclusion of other causes of syncope. Blood pressure of these 12 patients (pts.) after admission was 145 +/- 16/83 +/- 6 mmHg; at that time the pts. were treated with 2.6 +/- 1.6 different antihypertensive agents, and 67% of the pts. received a combination therapy. After reevaluation of treatment the pts. could be discharged with 1.3 +/- 0.7 different antihypertensive agents (significant difference, p < 0.02); in 25% of pts. (p < 0.05) combination therapy was still necessary. Before discharge casual blood pressure was 156 +/- 17/85 +/- mmHg (with the patient in the sitting position); average daytime ambulatory blood pressure was 145 +/- 18/80 +/- 5 mmHg. Three months after discharge 91% of pts. remained free of a new syncope. Orthostatic hypotension is a frequent cause of syncope in the hypertensive elderly; thus, their blood pressure should be checked more often in the sitting and standing position and by ambulatory monitoring.