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Review
. 2024 Dec 3:48:101154.
doi: 10.1016/j.lanepe.2024.101154. eCollection 2025 Jan.

Hypertension and orthostatic hypotension in the elderly: a challenging balance

Julia Wiersinga  1   2 , Sofie Jansen  1 , Mike J L Peters  3 , Hanneke F M Rhodius-Meester  4   5 , Marijke C Trappenburg  6 , Jurgen A H R Claassen  7   8 , Majon Muller  1   2
Affiliations
Review

Hypertension and orthostatic hypotension in the elderly: a challenging balance

Julia Wiersinga et al. Lancet Reg Health Eur. .

Abstract

Hypertension and orthostatic hypotension (OH) frequently coexist in the older population, both stemming from impaired blood pressure (BP) regulation. Managing hypertension in patients with OH presents a significant clinical challenge, particularly in frail older adults who are also prone to falls. Hypertension treatment is often suboptimal in this population due to concerns over the potential increased risk of falls associated with treatment. However, current clinical guidelines provide limited guidance on managing this complex issue. This review explores the pathophysiology of hypertension and OH, reviews existing guidelines, and examines the evidence surrounding hypertension management in patients with OH. Additionally, we provide an overview of research focused on frail older adults and offer expert-opinion-based recommendations for the management of hypertension and OH in routine clinical practice.

Keywords: Hypertension; Older patients; Orthostatic hypotension.

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Conflict of interest statement

We declare the following interests. Hanneke-Rhodius Meester has received grants from TKI-Health Holland (DAILY, project number LSHM19123-HSGF), Alzheimer Nederland (InterACT, project number WE.08-2022-06), ZonMW (Memorabel Dementia Fellowship 2021, projectnumber 10510022110004), Horizon 2022 EU (PROMINENT, project number 101112145), Combinostics. Jurgen Claassen receives annual research budget form Radboud UMC, and research grants (paid to institution) from Alzheimer Nederland, ZonMW (NWO), Gieskes Strijbis Fund. He has given presentations at Eisai, BMS, Lilly, Several small Dutch conference organisers, is on the scientific advisory board of Alzheimer Nederland and associate editor at JCBFM. Majon Muller has given presentations for ViV–HIV and aging, CarVascGer congress–Heart failure medication and fall risk, Heart failure master class—GDMT in older heart failure patients, Dutch Lipids Experience—Statin treatment in the old. She is on the supervisory board for stichting Hartekind and board member at Dutch Internal Medicine association—NIV.

Figures

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Graphical abstract
Fig. 2
Fig. 2
OH Assessment and hypertension treatment in older patients with hypertension. Abbreviations: ABPM; ambulatory blood pressure measurement, ACE: angiotensin converting enzyme, ARB: angiotensin receptor blocker, CCB: calcium channel blocker, OH: orthostatic hypertension.
See this image and copyright information in PMC

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