Is there a risk of orthostatic hypotension associated with antihypertensive therapy in geriatric inpatients?

To determine the risk of orthostatic hypotension (OH) due to antihypertensive therapy in a geriatric inpatient population. This observational cohort study included 388 patients (mean age 80.7, 68.5% female) hospitalized in a geriatric clinic. OH risk was evaluated by orthostatic testing (OT), with manual measurement of blood pressure after 30 minutes supine (T0), and after 1 (T1), 3 (T3), and 5 (T5) minutes after rising in a vertical position. OH was defined by a ≥ 20 mmHg decrease in systolic blood pressure and/or a ≥ 10 mmHg decrease in diastolic blood pressure. Age ≥ 80 years, history of falls and prescribed medication (antihypertensive, hypotensive, or both), were not significantly associated with OH or with OT positivity at any time point. The multivariate analysis showed that OH risk in T1 was 2.34 times higher than in T3 and T5 (confidence interval [1.49–3.68], P < 0.001). Presenting symptoms during OT increased the risk of obtaining a positive result by 3.67 times (confidence interval [1.52–8.87], P = 0.004). With each increase in one mini-mental state examination (MMS) point, a 9.9% decrease of OT positivity was observed (odds ratio = 0.907, confidence interval [0,84–0,98], P = 0.016). The prescription of antihypertensive drugs was not significantly associated with the risk of OH in this geriatric inpatient population. OH screening in patients with cognitive impairment is critical, as with each decrease in one MMS point, OH risk increased by almost 10%.