Understanding the risk of medications associated with orthostatic hypotension in older adults

Orthostatic hypotension (OH) is a common, disabling condition associated with serious adverse outcomes in later life, yet one that is frequently overlooked. Over 250 medications are reported to cause OH and the risk rises with cumulative drug use. Despite this, guidelines for medication-related OH are scarce and conflicting, based on low-quality studies and expert opinion.

This thesis has addressed the gap in knowledge through a systematic review and meta-analysis to understand which specific medications are associated with OH and three epidemiological studies of UK primary care electronic health records to examine the risk of OH associated with drug exposure and drug-combination exposure, in older people.

The Office for National Statistics has forecast that by 2040, one in seven citizens will be aged 75 or over. An aging population faces a number of healthcare challenges, including an increase in the prevalence of chronic conditions, and changes in physiology that increase the risk of falls and other accidents. Postural – or orthostatic – hypotension is a condition in which a person’s blood pressure drops significantly when they stand up from sitting or lying down. When blood pressure drops suddenly on standing, not enough blood flow reaches a person’s brain and they can experience symptoms such as dizziness, blurred vision, and falls.

Cini has produced a fantastic public engagement video on drug-induced postural hypotension in older people, to support patients, their carers and clinicians. The video covers insight from 2 papers in her PhD thesis. 

Revealing Which Medications Can Cause Postural Hypotension 

UCL School of Pharmacy

MRC Unit for Lifelong Health and Ageing