Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden.

Abstract

BACKGROUND:

the relationship between antihypertensive medication and orthostatic hypotension in older persons remains ambiguous, due to conflicting observational evidence and lack of data of clinical trials.

OBJECTIVE:

to assess the effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment.

METHODS:

a total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study. This randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment, using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). Orthostatic hypotension was defined as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure on standing from a seated position. Outcome was the absence of orthostatic hypotension at 4-month follow-up. Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses.

RESULTS:

at follow-up, according to intention-to-treat analyses, of the 86 persons assigned to discontinuation of antihypertensive medication, 43 (50%) were free from orthostatic hypotension, compared with 29 (38%) of the 76 persons assigned to continuation of medication [RR 1.31 (95% confidence interval (CI) 0.92-1.87); P = 0.13]. Per-protocol analysis showed that recovery from orthostatic hypotension was significantly higher in persons who completely discontinued all antihypertensive medication (61%) compared with the continuation group (38%) [RR 1.60 (95% CI 1.10-2.31); P = 0.01].

CONCLUSION:

in older persons with mild cognitive impairment and orthostatic hypotension receiving antihypertensive medication, discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension.

• Authors: Justine E F Moonen, Jessica C Foster-Dingley, Wouter de Ruijter, Jeroen van der Grond, Anton J M de Craen, Roos C van der Mast
• Journal: Age and ageing (Age Ageing) Vol. 45 Issue 2 Pg. 249-55 (Mar 2016) ISSN: 1468-2834 [Electronic] England
• PMID: 26758532 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Antihypertensive Agents

Topics

• Aged
• Aged, 80 and over
• Antihypertensive Agents (administration & dosage, adverse effects)
• Blood Pressure (drug effects)
• Cognition
• Cognitive Dysfunction (complications, diagnosis, psychology)
• Drug Administration Schedule
• Female
• Geriatric Assessment
• Humans
• Hypertension (complications, diagnosis, drug therapy, physiopathology)
• Hypotension, Orthostatic (chemically induced, diagnosis, physiopathology, prevention & control)
• Intention to Treat Analysis
• Male
• Netherlands
• Odds Ratio
• Predictive Value of Tests
• Risk Factors
• Time Factors
• Treatment Outcome