Abstract
Fifty cases of orthostatic hypotension in the elderly are analysed. Three main modes of presentation were identified: (1) falls or mobility problems; (2) mental confusion or dementia; or (3) predominantly cardiac symptoms. Selected case histories are given to illustrate diagnostic difficulties. Medication was responsible for orthostatic hypotension in 66% of patients and striking examples of polypharmacy were encountered. However, 34% of cases were not iatrogenic. Only 14% of patients had overtly postural symptoms. A high index of suspicion is needed to diagnose orthostatic hypotension in the elderly and the condition is often overlooked. The paper provides useful diagnostic clues for clinicians.
Full text
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blake A. J., Morgan K., Bendall M. J., Dallosso H., Ebrahim S. B., Arie T. H., Fentem P. H., Bassey E. J. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988 Nov;17(6):365–372. doi: 10.1093/ageing/17.6.365. [DOI] [PubMed] [Google Scholar]
- Davie J. W., Blumenthal M. D., Robinson-Hawkins S. A model of risk of falling for psychogeriatric patients. Arch Gen Psychiatry. 1981 Apr;38(4):463–467. doi: 10.1001/archpsyc.1981.01780290097010. [DOI] [PubMed] [Google Scholar]
- Gross M., Bannister R., Godwin-Austen R. Orthostatic hypotension in Parkinson's disease. Lancet. 1972 Jan 22;1(7743):174–176. doi: 10.1016/s0140-6736(72)90571-5. [DOI] [PubMed] [Google Scholar]
- MULLER O. F., GOODMAN N., BELLET S. The hypotensive effect of imipramine hydrocloride in patients with cardiovascular disease. Clin Pharmacol Ther. 1961 May-Jun;2:300–307. doi: 10.1002/cpt196123300. [DOI] [PubMed] [Google Scholar]
- Myers M. G., Kearns P. M., Kennedy D. S., Fisher R. H. Postural hypotension and diuretic therapy in the elderly. Can Med Assoc J. 1978 Sep 23;119(6):581–585. [PMC free article] [PubMed] [Google Scholar]
- SHY G. M., DRAGER G. A. A neurological syndrome associated with orthostatic hypotension: a clinical-pathologic study. Arch Neurol. 1960 May;2:511–527. doi: 10.1001/archneur.1960.03840110025004. [DOI] [PubMed] [Google Scholar]
- Sharma J. C., MacLennan W. J. Causes of ataxia in patients attending a falls laboratory. Age Ageing. 1988 Mar;17(2):94–102. doi: 10.1093/ageing/17.2.94. [DOI] [PubMed] [Google Scholar]
- Sixt E., Landahl S. Postural disturbances in a 75-year-old population: I. Prevalence and functional consequences. Age Ageing. 1987 Nov;16(6):393–398. doi: 10.1093/ageing/16.6.393. [DOI] [PubMed] [Google Scholar]
- Thomas J. E., Schirger A., Fealey R. D., Sheps S. G. Orthostatic hypotension. Mayo Clin Proc. 1981 Feb;56(2):117–125. [PubMed] [Google Scholar]
- Watson R. D. Treating postural hypotension. Br Med J (Clin Res Ed) 1987 Feb 14;294(6569):390–391. doi: 10.1136/bmj.294.6569.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson J. A., Smith R. G. The prevalence and aetiology of long-term L-dopa side-effects in elderly parkinsonian patients. Age Ageing. 1989 Jan;18(1):11–16. doi: 10.1093/ageing/18.1.11. [DOI] [PubMed] [Google Scholar]