Which Medications Can Cause Postural Hypotension
Orthostatic hypotension (orthostatic hypotension), defined as a reduction in systolic blood pressure (BP) of ≥20 mm Hg or diastolic BP of ≥10 mm Hg within 3 min of assuming an erect posture, is common in older people and often caused by medications. It is associated with serious adverse outcomes in later life, including falls, ischaemic coronary events, strokes and cognitive impairment.
Causes of orthostatic hypotension are neurogenic (inherent structural lesions of autonomic pathways, for example, Parkinson disease) or non-neurogenic (non-inherent, functional causes of autonomic failure). Among the latter, medications are the most typical cause. Over 250 medications are reported to cause orthostatic hypotension. There is an increased risk of orthostatic hypotension with combinations of drugs causing a cumulative effect.
Recent guidelines warn about the synergistic effect of multiple medications causing orthostatic hypotension in older adults with polypharmacy. Recent studies have identified drug groups associated with orthostatic hypotension, including cardiovascular drugs (such as beta-blockers and certain antihypertensives), psychoactive drugs (such as tricyclic antidepressants and antipsychotics) and uroselective alpha blockers, among others. However, there is limited evidence on the potential for harm with current practice, including which drugs are commonly coprescribed that may increase risk of orthostatic hypotension. Previous studies have described common co-prescriptions, or “clusters” of drugs among older adults with multimorbidity. However, none describe common drug combinations associated explicitly with orthostatic hypotension.