Screening for orthostatic hypotension in the geriatric population in a real-world primary care setting reduces prescribed antihypertensive medications

Background To determine if outpatient screening for orthostatic hypotension (OH) in the geriatric population results in fewer prescribed antihypertensive medications and if a relationship exists between OH and specific pharmacologic classes of antihypertensive medications. Materials and methods Patients ≥ 65 years were screened for OH, defined as a decrease in systolic blood pressure (SBP)≥20mm Hg or a decrease in diastolic blood pressure (DBP)≥10mm Hg after standing for 3 minutes. Sitting blood pressure (BP) was measured after patients had been seated quietly in an exam room. Patients then stood for approximately 3 minutes at which time standing BP was recorded. Results OH prevalence was 18%. Standing DBP was significantly different between the two groups (70mmHg ± 18, 80mmHg ± 13, P=0.007). Compared to patients without OH, patients with OH were more likely to have been previously prescribed beta-blockers (56% vs. 32%, P=0.056) and potassium-sparing diuretics (11% vs. 1%, P=0.026). Physicians discontinued an antihypertensive medication more often in patients who screened positive for OH than in to those who did not (17% vs. 4%, P=0.037). Calcium channel blockers were the most frequently discontinued class of medication. Conclusion Asymptomatic OH is prevalent in geriatric patients. Screening for OH may lead to de-escalation of antihypertensive regimen and a reduction in polypharmacy. Positive screening for OH was associated with de-prescribing of antihypertensive medications. Prior use of beta-blockers and potassium-sparing diuretics was most largely associated with OH.