From the Guidelines
The patient's blood pressure change from orthostatic hypotension to persistent hypertension is most likely caused by medications or substances that increase blood pressure, as highlighted in the 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. This change can occur due to various factors, including:
- Drug-drug or drug-food interactions
- Over-the-counter substances, illicit drugs, or herbal products that impair blood pressure control
- Prescription medications, such as vasopressors like midodrine or fludrocortisone, used to treat orthostatic hypotension The clinical assessment of hypertension should include a careful history of substances that may affect blood pressure control, and when feasible, drugs associated with increased blood pressure should be reduced or discontinued, and alternative agents should be used 1. Key considerations in managing this patient's condition include:
- Careful medication adjustment to reduce or discontinue pressor medications
- Introduction of antihypertensives that can control blood pressure without severely worsening orthostatic symptoms
- Close monitoring of blood pressure and adjustment of treatment as needed to prevent complications from persistent hypertension.
From the Research
Possible Causes of Blood Pressure Change
- The patient's blood pressure changed from orthostatic hypotension to persistent hypertension (>155/85) in all positions, which could be due to various factors such as:
- Improvement in the underlying condition that caused orthostatic hypotension, such as dehydration or blood loss, as mentioned in 2
- Discontinuation of medications that may have been contributing to orthostatic hypotension, as discussed in 3 and 4
- Development of a new condition that causes hypertension, such as kidney disease or sleep apnea
- It is also possible that the patient's blood pressure was not accurately measured initially, or that there were errors in the measurement process, as highlighted in 5 and 6
Role of Medications
- Certain medications can cause orthostatic hypotension, including alpha 1-blockers, adrenergic blockers, and centrally acting drugs, as mentioned in 4
- Discontinuation of these medications or adjustment of their doses may have contributed to the change in blood pressure
- On the other hand, some medications can cause hypertension, and the patient may have started taking such medications, as discussed in 3
Importance of Accurate Diagnosis
- Accurate diagnosis of the underlying condition is crucial to determine the cause of the blood pressure change, as emphasized in 6
- A thorough physical examination, medical history, and laboratory tests may be necessary to determine the cause of the hypertension, as mentioned in 5 and 2
Management and Treatment
- Management and treatment of the patient's condition will depend on the underlying cause of the hypertension, as discussed in 3 and 6
- Lifestyle modifications, such as dietary changes and exercise, may be recommended to help manage hypertension, as mentioned in 5
- Medications may be prescribed to control hypertension, and the patient will need to be monitored regularly to adjust the treatment plan as needed, as highlighted in 3 and 4