Drug-induced orthostatic hypotension in the elderly: avoiding its onset

The prevalence of orthostatic hypotension in the elderly is reported to be 5 to 33%. This high prevalence contributes to the risk of syncope and falls in old age. Drugs are a major cause of postural hypotension. Changes in pharmacokinetics and pharmacodynamics occur with aging in relation to many drugs, resulting in delayed elimination and increased bioavailability. Therefore, drugs with an antihypertensive action (diuretics, calcium antagonists, beta-blockers, ACE inhibitors, alpha 1-blockers, and centrally acting antihypertensives) have a more pronounced effect in the elderly. Nitrates, antiparkinsonian drugs, antidepressants and antipsychotics all cause hypotension as a known adverse effect. When assessing orthostatic hypotension in the elderly, drug treatment should always be reviewed. Whenever possible, antihypertensive drugs should be discontinued, and the dosages of essential drugs should be reduced.