Antihypertensive medications for hypotension
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Antihypertensive Medications and Their Association with Hypotension
Antihypertensive medications are widely used to manage high blood pressure, but they can also cause hypotension (abnormally low blood pressure) as an adverse effect. This risk is particularly important in certain populations, such as older adults, patients with comorbidities, and those undergoing hemodialysis Sari2024Zoccali2024Markandeywar2024+1 MORE.
Common Antihypertensive Drug Classes Linked to Hypotension
Several classes of antihypertensive drugs are frequently associated with hypotension. These include angiotensin-converting enzyme (ACE) inhibitors, beta blockers, diuretics, and alpha blockers. Among these, diuretics and alpha blockers are especially notable for their potential to cause postural or orthostatic hypotension, which is a drop in blood pressure upon standing Sari2024Meredith2001Markandeywar2024. Beta blockers and ACE inhibitors are also implicated, but the risk varies depending on the specific drug and patient characteristics Sari2024Zoccali2024Markandeywar2024.
Orthostatic Hypotension and Antihypertensive Therapy
Orthostatic hypotension is a common side effect in patients treated with antihypertensive medications. Studies show that the use of diuretics increases the risk of orthostatic hypotension, while calcium channel blockers (CCBs) may reduce this risk . In elderly patients, the risk of postural hypotension is higher, but not all antihypertensive classes contribute equally. For example, beta blockers are generally not associated with symptomatic postural hypotension, whereas older alpha blockers like prazosin have a higher risk, especially with the first dose. Newer alpha blockers such as doxazosin have a lower risk due to a more gradual onset of action .
Antihypertensive Medications in Special Populations
In hemodialysis patients, the use of beta blockers, ACE inhibitors, angiotensin II receptor blockers (ARBs), and diuretics is associated with a higher risk of intradialytic hypotension compared to calcium channel blockers . In lung transplant recipients, antihypertensive medications did not significantly increase the risk of orthostatic hypotension, suggesting that other factors may also play a role in this population .
Deprescribing and Medication Adjustment in Older Adults
For older adults, especially those experiencing symptoms of hypotension, deprescribing antihypertensive medications can reduce the frequency of hypotensive episodes without causing blood pressure to rise above target levels. Pharmacist-guided deprescribing, particularly of beta blockers and diuretics, has been shown to significantly reduce hypotensive symptoms .
Drug Repositioning and Hypotension as a Signal
Drugs that frequently cause hypotension as a side effect may have potential as antihypertensive agents. Data-driven approaches using pharmacovigilance systems can help identify such drugs for possible repositioning as antihypertensive therapies .
Concomitant Use of Other Medications
The risk of hypotension may also be influenced by the use of non-antihypertensive drugs, such as neuroleptics, benzodiazepines, opioids, and antidepressants, which can contribute to low blood pressure when used alongside antihypertensive medications . However, studies show that the addition of certain medications, such as tadalafil, does not significantly increase the risk of hypotension-related adverse events when used with antihypertensive drugs .
Conclusion
Antihypertensive medications are a common cause of hypotension, especially in older adults and patients with multiple comorbidities. Diuretics and alpha blockers are most strongly associated with orthostatic hypotension, while calcium channel blockers may be safer in this regard. Deprescribing or adjusting antihypertensive therapy can help manage hypotension in vulnerable patients. Awareness of both antihypertensive and non-antihypertensive drugs that can cause hypotension is essential for safe patient care Sari2024Zoccali2024Meredith2001+4 MORE.
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Most relevant research papers on this topic
Identification of potentially causative drugs associated with hypotension: A scoping review
Nonantihypertensive drugs, such as neuroleptics, alpha-1 blockers, benzodiazepines, opioids, and antidepressants, can cause hypotension in adults, highlighting the need for increased awareness among healthcare professionals.
Antihypertensive Drug Treatment and the Risk for Intrahemodialysis Hypotension
Using and -blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers, and diuretics may increase the risk of intradialytic hypotension in hemodialysis patients compared to calcium channel blockers.
EFFECTIVENESS & TOLERABILITY OF METOPROLOL ER, TELMISARTAN & CHLORTHALIDONE IN ESSENTIAL HYPERTENSION PATIENTS WITH STABLE CAD: INDIAN REAL-WORLD STUDY STRATIFIED BY COMORBIDITIES
Orthostatic hypotension is common in hypertension patients, and the choice and change of antihypertensive classes should be considered in patients with suspected orthostatic hypotension.
Desprescribing antihypertensives in older people in primary care: subgroup analysis of the MINOR randomised clinical trial
Pharmacists can optimize hypertension management in older adults by deprescribing antihypertensives and limiting symptomatic hypotension through home blood pressure monitoring.
Orthostatic Hypotension and Antihypertensive Treatment in Lung Transplant Recipients: A Cross-Sectional Study.
Orthostatic blood pressure dysregulation is prevalent among lung transplant recipients, but antihypertensive medications do not increase the risk of orthostatic hypotension.
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