title: Prevalence of orthostatic hypotension and relationship with drug use amongst older patients.
abstract: BACKGROUND
  Orthostatic hypotension (OH) is said to be highly prevalent in older people. Drugs are often involved as causative factor. Nevertheless, few data are available about the prevalence of OH and its relationship with drugs in olders.
  
  
  OBJECTIVE
  To review data about (i) the prevalence and characteristics of OH in older patients; and (ii) the relationship between OH and drugs.
  
  
  METHODS
  Review of publications from Ovid (PubMed) from 1980 to May 2011 using the following key words: "orthostatic hypotension" combined with "elderly" or equivalent for the analysis of prevalence (first search) and "orthostatic hypotension" combined with "drugs" or equivalent to assess the relationship between OH and drugs (second search).
  
  
  RESULTS
  Fifty-one publications (of which 14 with original data) were retrieved from the prevalence search, 31 for the second search (8 with original data: 7 retrospective studies and 1 prospective cohort study) and 12 reviews or experts opinions. Prevalence of OH varies according to the characteristics of the subjects, the settings of the studies, and the procedures of blood pressure measurement. In acute geriatrics units, two studies reported a prevalence of over 30% and one study mentioned that 68% of the patients presented with at least one episode during the day. OH was associated with several geriatric problems: gait disorders, balance disorders, falls, cerebral hypoperfusion, transient ischemic attacks, cognitive impairment, acute myocardial infarct and systolic hypertension. OH can also be asymptomatic or with atypical presentation: falls, gait disorders and confusion. Psychotropic agents (antipsychotics, sedatives, antidepressants), and cardiovascular drugs (antihypertensive agents, vasodilators, diuretics) were associated with OH.
  
  
  CONCLUSIONS
  If the hypothesis of causality between drug treatment and OH is confirmed, the identification of the involved drugs could be of value for the prevention of OH and its complications. In this context, the Working Group Pharmacology Pharmacotherapy and Pharmaceutical Care of the Belgian Society of Gerontology and Geriatrics proposes to conduct a multicentre study to assess the prevalence of OH in Belgian acute geriatrics units and its relationship with drugs.
authors: Service de Geriatrie, Cliniques Universitaires de Bruxelles, Hôpital Erasme. thierry.pepersack@erasme.ulb.ac.be
authors: T
authors: T
authors: Pepersack
authors: C
authors: C
authors: Gilles
authors: M
authors: M
authors: Petrovic
authors: A
authors: A
authors: Spinnewine
authors: H
authors: H
authors: Baeyens
authors: I
authors: I
authors: Beyer
authors: B
authors: B
authors: Boland
authors: O
authors: O
authors: Dalleur
authors: J
authors: J
authors: De Lepeleire
authors: D
authors: D
authors: Even-Adin
authors: M C
authors: MC
authors: Van Nes
authors: A
authors: A
authors: Samalea-Suarez
authors: A
authors: A
authors: Somers
mesh_terms: D000368:Aged; D015577:Geriatric Assessment; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence