Anticoagulation should be started in older patients with atrial fibrillation

Introduction.– Orthostatic hypotension (OH) in geriatric patients is often considered to be related to blood lowering medications (BLM). We tested the hypothesis that this might not be the case. Methods.– OH (≥20/10mmHg decrease in systolic/diastolic blood pressure) was screened in 100 older inpatients (85±5years, 59% women) able to stand up (3minutes) during the first two days after admission in an academic geriatric ward. We analyzed the use of BLM (ACE/angiotensin inhibitors, calcium channel blockers, -blockers, diuretics, 1-blockers, central -agonists, nitrates) and expressed their dosage with the number of defined daily dose (DDD). Results.– No difference in BLM was observed between 33 patients with OH and 67 patients without OH in terms of use (73 vs. 85%), number (1.76 vs. 1.57 drugs) or mean dosage (1.8 vs. 1.7 DDD). No statistical difference was found at the drug level between patients with and those without OH (ACE/angiotensin inhibitors 42 vs. 42%; calcium channel blockers 24 vs. 24%; -blockers 48 vs. 37%; diuretics 30 vs. 30%; 1-blockers 12 vs. 6%, nitrates 9 vs. 6%; central -agonists 3 vs. 1%). OH prevalence was 30% in the 80 patients receiving BLMand 45% in the 20 other patients (P=0.31). OHprevalence was not associated with BLM number (Odds Ratio 1.09 per unit ofDDD increase, 95%CI: 0.8–1.5,P=0.57), norwith theirdosage (Odds Ratio 1.04, 95% CI: 0.8–1.3, P=0.74). Conclusion.– This study found no evidence nor trend for an association between orthostatic hypotension and blood lowering medications in geriatric inpatients.