From the Guidelines
Orthostatic hypertension is managed by prioritizing non-pharmacological approaches as the first-line treatment, focusing on lifestyle modifications and avoiding medications that worsen the condition, as recommended by the 2024 ESC guidelines 1. The management of orthostatic hypertension involves a comprehensive approach that considers the patient's overall health and medication regimen.
- Non-pharmacological interventions are crucial, including increasing fluid intake and salt consumption, unless contraindicated, as well as physical countermeasures like crossing legs when standing and wearing compression stockings.
- Medications that exacerbate orthostatic hypertension should be adjusted or discontinued when possible, and alternative BP-lowering therapies should be considered to minimize the risk of worsening orthostatic hypertension 1.
- The 2024 ESC guidelines emphasize the importance of testing for orthostatic hypotension before starting or intensifying BP-lowering medication, by measuring BP 1 and/or 3 min after standing, following a 5-minute period of sitting or lying down 1.
- While the provided evidence primarily focuses on orthostatic hypotension, the principles of managing orthostatic hypertension involve a similar approach, prioritizing patient safety and minimizing the risk of adverse effects on blood pressure regulation.
- It is essential to note that the management of orthostatic hypertension requires careful consideration of the patient's individual needs and health status, and may involve collaboration with healthcare professionals to optimize treatment outcomes.
From the Research
Management of Orthostatic Hypertension
The management of orthostatic hypertension is a complex issue, and there is limited evidence available to guide treatment decisions.
- The definition of orthostatic hypertension (OHT) varies across different studies, making it challenging to compare relevant outcomes 2.
- There is evidence to suggest that orthostatic hypertension is associated with a higher risk of cardiovascular outcomes, particularly in patients receiving intensive blood pressure treatment 3.
- The use of alpha1-blockers, such as doxazosin, may be beneficial in reducing blood pressure in patients with orthostatic hypertension, particularly when added to combination therapy with calcium channel blockers and angiotensin II receptor blockers or ACE inhibitors 4.
- Triple fixed-dose combination therapy with an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic may also be effective in reducing blood pressure and improving cardiovascular outcomes in patients with orthostatic hypertension 5.
Treatment Approaches
The treatment of orthostatic hypertension typically involves a combination of lifestyle modifications and pharmacological interventions.
- Lifestyle modifications may include increasing salt intake, avoiding dehydration, and exercising regularly.
- Pharmacological interventions may include the use of alpha1-blockers, calcium channel blockers, and thiazide diuretics, either alone or in combination.
- However, the evidence for the effectiveness of these interventions in managing orthostatic hypertension is limited, and further research is needed to determine the best approach to treatment 2, 3.
Clinical Implications
The clinical implications of orthostatic hypertension are significant, and further research is needed to fully understand the condition and its treatment.
- Orthostatic hypertension is associated with an increased risk of cardiovascular outcomes, and effective management of the condition is essential to reduce this risk 3.
- The use of combination therapy, including alpha1-blockers and triple fixed-dose combinations, may be beneficial in reducing blood pressure and improving cardiovascular outcomes in patients with orthostatic hypertension 4, 5.
- However, further research is needed to determine the most effective treatment approach and to fully understand the clinical implications of orthostatic hypertension 2.