Blood pressure lowering therapy in older people: Does it really cause postural hypotension or falls?

Abstract

Hypertension is a highly prevalent condition among older people, but many physicians avoid aggressive treatment in this age group due to concerns about adverse effects such as orthostatic hypotension and falls. Orthostatic hypotension, which also increases in prevalence with increasing age, has been considered to be associated with antihypertensive therapy. Both orthostatic hypotension and antihypertensive medications are considered independent yet closely related predictors for falls among older people. The prescription of antihypertensive therapy among the elderly remains a long-standing controversy in geriatric medicine due to ongoing concerns about potential complications such as falls, despite conclusive evidence supporting the treatment of hypertension even among the very elderly. However, recent evidence suggests a dose-dependent relationship between blood pressure lowering therapy and falls among older individuals with preexisting risk factors for falls. In response to the spate of revisions in hypertension treatment targets for older patients in international guidelines and the recent evidence on antihypertensive therapy and falls, this review article examines the complex relationship between hypertension, antihypertensives, orthostatic hypotension, and falls among older patients.

Keywords :

• Accidental falls
• aged
• antihypertensives
• hypertension
• orthostatic hypotension

Declaration of interest

This work was supported by Ministry of Science, Technology, and Innovation Science Funds grant SF017-2013. The authors have also received a research grant from the University of Malaya (RP-010-2012A) and a high-impact research grant from the Ministry of Education (UM.C/625/1/HIRMOHE/ASH/02). There are no relationships of this research with any industry. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.