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Orthostatic hypotension in elderly patients

PhD ceremony:Ms L. (Laura) Hartog
When:February 08, 2017
Supervisor:prof. dr. H.J.G. (Henk) Bilo
Co-supervisors:dr. K.J.J. van Hateren, dr. N. (Nanno) Kleefstra
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Orthostatic hypotension in elderly patients

Orthostatic hypotension (OH) is defined as a decrease in blood pressure (BP) after changing from supine to standing position and is frequently diagnosed in the elderly population. Information is limited with regard to differences between the various methods to determine OH, and about the consequences when OH is present.

It is generally assumed that OH is causally related to falling, cardiovascular complications and mortality, despite the sparse evidence. Antihypertensive treatment is one of the causes of OH. Information regarding the relation between BP and mortality risk is lacking in a nursing home population, a population in which the need for strict antihypertensive treatment is questionable already. Finally, the role of health related quality of life (HRQOL) in this specific population is important and perhaps even more important than clinical parameters.

Based on the results of this thesis we conclude that the approach to OH in elderly patients needs to be reconsidered. OH measurements according to the current International consensus definition are not related to important clinical endpoints and therefore are not useful in daily practice. Furthermore, the mortality prediction capabilities of BP and HRQOL are very limited in a nursing home population.

Since OH measurements in elderly patients lack additional value in clinical decision-making or predicting outcomes in the majority of elderly patients, we recommended that OH measurement should not be part of usual care in clinical decision-making. It seems to be more useful to inquire after orthostatic complaints rather than measuring OH.