Dizziness in the elderly and calcium channel antagonists.
Because of the benefit-risk ratio in their favor, calcium channel antagonists are considered to be a safe form of treatment of hypertension in the elderly. However, the outcome of dizziness in some patients over 65 yr old during the first few days of treatment with these drugs has to be considered. Five cases of "malaise" have been mentioned, which occurred during the first few days of treatment. The imputability of the drug in question has been evaluated. Additional factors have been found, ie orthostatic hypotension whatever its mechanism, and association with diuretics, with or without hyponatremia. The above-mentioned cases led to a study in 10 supine elderly women (mean age 85 +/- 3 yr) with normal blood pressure. In this study, systolic and diastolic blood pressure were monitored after a 20-mg oral dose of nicardipine for 3 h. Even in the supine position, a significant fall in blood pressure was observed as early as the 15th min after administration, which could be significant, occasionally reaching 45% of the initial value. Before administering a calcium channel antagonist to an elderly person, orthostatic hypotension has to be investigated. Association with a diuretic results in high risk due to hypovolemia that can enhance the vasodilatory effect of calcium antagonists.
Le Jeunne
C
C
Laboratoire de Thérapeutique Appliquée, Hôpital Laennec, Paris, France.
Hugues
F C
FC
Munera
Y
Y
Ozanne
H
H
D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004244:Dizziness / Q000139:chemically induced*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D009529:Nicardipine / Q000494:pharmacology
D002121:Calcium Channel Blockers; D004232:Diuretics; D009529:Nicardipine