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Hemodynamic response to orthostatic stress in the elderly with systolic systemic hypertension before and after
S Vardan1, N E Hill, K G Mehrotra
1Department of Medicine, Veterans Administration Medical Center, Syracuse 13210.
Insights
Long-term hydrochlorothiazide therapy in elderly systolic hypertension patients effectively lowered blood pressure without worsening orthostatic stress responses. This study demonstrates thiazide diuretics are safe for managing hypertension in older adults.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Elderly individuals with systolic hypertension often experience orthostatic stress.
- Concerns exist regarding thiazide diuretic therapy exacerbating orthostatic hypotension in this population.
Purpose of the Study:
- To investigate the hemodynamic effects of long-term hydrochlorothiazide therapy on elderly patients with systolic hypertension.
- To assess the impact of hydrochlorothiazide on orthostatic stress responses.
Main Methods:
- Sixteen elderly men (mean age 70 years) with systolic hypertension received hydrochlorothiazide (50 mg daily).
- Hemodynamic variables were measured in supine and tilted positions (0 and 15 minutes) before, after 1 month, and after 1 year of therapy.
- Intermittent foot movements were used to simulate standing and minimize gravitational pooling.
Main Results:
- Systolic and diastolic blood pressure significantly decreased after 1 month and was maintained up to 1 year.
- The significant reduction in systolic blood pressure upon tilting, observed before therapy, was not present after 1 month or 1 year of treatment.
- Diastolic blood pressure at 0 minute of tilt was significantly reduced only at 1 year.
Conclusions:
- Long-term hydrochlorothiazide therapy effectively reduces blood pressure in elderly patients with systolic hypertension.
- Thiazide diuretic therapy does not appear to exacerbate the hypotensive response to orthostatic stress in this patient group.
- Hydrochlorothiazide can be safely used for managing hypertension in older adults, even with orthostatic considerations.
Abstract:
The hemodynamic effects of orthostatic stress in elderly subjects with systolic hypertension were studied before and after long-term hydrochlorothiazide therapy (50 mg daily). Sixteen nondiabetic men aged 70 +/- 1 (SE) years participated in the study initially, and 12 completed 1 year of therapy. Patients underwent 45 degrees head-up incline on a tilt table before, after 1 month and after 1 year of therapy. Hemodynamic variables were measured in the following situations: (1) the supine position, (2) immediately after completion of passive 45 degrees head-up position at 0 minute, (3) at 15 minutes in the tilted state while patients performed intermittent foot movements to minimize gravitational pooling and simulate the standing position outside the laboratory, and (4) after returning to the supine position. Systolic and diastolic blood pressure (BP) decreased significantly after 1 month of therapy, and this reduction was maintained up to 1 year in all aforementioned body positions, with the exception of diastolic BP at 0 minute of tilt, which was significant at 1 year only. Before therapy was begun, there was a significant reduction in systolic BP immediately after completion of tilting; however, this was statistically insignificant both at 1 month and 1 year of therapy. Thus, the data may help dispel the concern of exacerbating the hypotensive response to orthostatic stress in patients with systolic hypertension after long-term thiazide diuretic therapy.