Orthostatic hypotension: Is fludrocortisone the answer?

+Practice

In print

Pharmacotherapy

Orthostatic hypotension: Is fludrocortisone the answer?

27 March 2024

Linda Bryant

Wednesday 27 March 2024, 12:20 AM

Perform lying and standing blood pressure measurements with a manual sphygmomanometer [Image: soc7 on Pixabay]

Pharmacist prescriber Linda Bryant discusses the management of orthostatic hypotension in people with hypertension

Key points, Orthostatic hypotension occurs in approximately 10 per cent of people with hypertension. It is important to measure lying to standing blood pressure, Pract Green w Pale Yellow

Older People

References

Biaggioni I. Orthostatic hypotension in the hypertensive patient. Am J Hypertens 2018;31(12):1255–59.
Juraschek SP, Cortez MM, Flack JM, et al. Orthostatic hypotension in adults with hypertension: A scientific statement from the American Heart Association. Hypertension 2024;81(3):e16–30.
Juraschek SP, Hu JR, Cluett JL, et al. Orthostatic hypotension, hypertension treatment, and cardiovascular disease: An individual participant meta-analysis. JAMA 2023;330(15):1459–71.
Moroi MK, Ruzieh M, Ahmed A, et al. Prevention and management of supine hypertension in patients with orthostatic hypotension. Am J Ther 2021;28(2):e228–31.
Raber I, Belanger MJ, Farahmand R, et al. Orthostatic hypotension in hypertensive adults: Harry Goldblatt Award for Early Career Investigators 2021. Hypertension 2022;79(11):2388–96.
Reddin C, Murphy R, Hanrahan C, et al. Randomised controlled trials of antihypertensive therapy: does exclusion of orthostatic hypotension alter treatment effect? A systematic review and meta-analysis. Age Ageing 2023;52(4):afad044.
Veazie S, Peterson K, Ansari Y, et al. Fludrocortisone for orthostatic hypotension. Cochrane Database Syst Rev 2021;5(5):CD012868.

How to Treat

+How to treat

For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews

Wednesday 28 May 2025, 12:50 AM