Drug-induced orthostatic hypotension

Abstract

Orthostatic hypotension (OH) is one of the most significant symptoms in clinical practice. The development of OH in the short term is associated with such consequences as falls, decreased adherence to treatment, in the long term, OH is associated with dementia and an increase in overall mortality. One of the leading factors in the development of OH is drugs in this case, the term ‘drug-induced’ (DI) OH is used. The leading drugs that induce this symptom include antihypertensive drugs, vasodilators, as well as alpha-blockers and antidepressants. The risk factors for DI OH are old age, concomitant diseases, in particular arterial hypertension (AH). The question of OH in patients with AH is difficult. Оn the one hand, AH is a risk factor for OH, in addition, antihypertensive drugs are inducers of OH and an increase in the amount of antihypertensive drugs can lead to an increase in the risk of developing OH. On the other hand, optimal therapy for AH on the contrary, leads to a decrease in the severity of OH. The basis of the treatment of DI OH is the correction of therapy with the drug withdrawal or replacement. The leading methods of prevention and treatment are non-pharmacological, requiring the active participation of the patient – a certain algorithm for accepting an upright position, changing eating behavior and counter maneuvers. Pharmacological therapies play a minor role. Informing doctors, as well as the patients themselves, about the problem of DI OH plays an important role in the prevention of its consequences.