Article

Prevalencia de hipotensión ortostática en ancianos hipertensos tratados en atención primaria

Atención Primaria 28(3):151–157. DOI: 10.1016/S0212-6567(01)78924-X

ABSTRACT Objective
To find the prevalence of orthostatic hypotension (OH) and associated factors in elderly hypertensive patients in a primary care setting.

Design
Descriptive cross-sectional study.

Setting
La Marina Health Centre (an urban centre in Santander).

Patients
A random sample of 295 patients aged 65 years or older regularly assisted from hypertension.

Measurements and main results
Measurements of sitting and standing blood pressure were obtained. Orthostatic hypotension was defined as 20 mmHg or greater decrease in systolic or 10 mmHg or greater decrease in diastolic blood pressure after 1-minute or 5-minute standing. Associated diseases, symptoms upon standing, medication use, habits and other clinical assessments were also recorded. The prevalence of OH was 14.6%. The prevalence of systolic OH after 1-minute (OH-S1) and after 5-minute (OH-S5) standing was 5.8% in both, and the diastolic OH was 5.1% after 1-minute (OH-D1) and 4.1% after 5-minute (OH-D5) standing. By logistic regression analysis, association between higher level of systolic blood pressure and global OH was found, also with the presence of orthostatic intolerance symptoms (although only 25.6% of the patients with OH showed symptoms) and smoking. Beta-blockers and calcium channel blockers (different from dihydropyridines) use was associated with OH after 1-minute standing and smoking with OH after 5-minute standing.

Conclusions
The detected prevalence is high and justifies the case finding of OH in elderly hypertensive patients in primary care. The symptoms of orthostatic intolerance are correlated with OH, but only 1 out of 4 patients showed symptoms. Smoking could be related with OH, so beta-blockers and calcium channel blockers (different from dihydropyridines) use.

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