From the Guidelines
Orthostatic hypertension is not directly addressed in the provided guidelines, which focus on orthostatic hypotension and the management of elevated blood pressure and hypertension, but the key to managing orthostatic hypertension lies in understanding its relationship with supine hypertension and orthostatic hypotension. The management of patients with supine hypertension, who may also experience orthostatic hypotension, involves a careful approach to avoid worsening orthostatic hypotension while treating the elevated blood pressure.
- The guidelines recommend pursuing non-pharmacological approaches as the first-line treatment for orthostatic hypotension in patients with supine hypertension 1.
- It is also recommended to switch BP-lowering medications that worsen orthostatic hypotension to an alternative BP-lowering therapy, rather than simply de-intensifying therapy 1.
- Before starting or intensifying BP-lowering medication, testing for orthostatic hypotension is recommended by measuring BP 1 and/or 3 min after standing, following a period of sitting or lying down for 5 min 1.
- Maintaining BP-lowering drug treatment lifelong, even beyond the age of 85 years, if well tolerated, is advised for patients who are not moderately to severely frail 1. Given the lack of direct guidance on orthostatic hypertension, the approach should prioritize minimizing harm and optimizing blood pressure control, considering the patient's overall health status and potential for orthostatic hypotension.
- This might involve careful monitoring of blood pressure in different positions and adjusting medications to avoid exacerbating orthostatic changes.
- Non-pharmacological strategies, such as lifestyle modifications, could be beneficial but need to be tailored to the individual's condition, focusing on minimizing rapid blood pressure fluctuations.
From the FDA Drug Label
Prazosin hydrochloride capsules are indicated for the treatment of hypertension, to lower blood pressure. The FDA drug label does not answer the question.
From the Research
Orthostatic Hypertension Management
- Orthostatic hypertension is not directly addressed in the provided studies, but orthostatic hypotension is discussed in several studies 2, 3, 4, 5, 6.
- However, the management of orthostatic hypotension can provide some insights into the management of orthostatic hypertension.
- Lifestyle modifications such as weight loss, regular exercise, and low alcohol consumption can help reduce blood pressure in hypertensive patients 2.
- Individualized therapy, including weight loss, abstinence from or moderation in alcohol intake, regular exercise, restriction of sodium intake, and stress management, can also help reduce blood pressure in hypertensive patients 2.
- Alpha 1-adrenoceptor antagonists have been shown to be effective in reducing blood pressure in hypertensive patients, but they can also cause orthostatic hypotension 4, 5, 6.
- To avoid orthostatic hypotension during antihypertensive therapy, it is recommended to use long-acting alpha 1-adrenoceptor antagonists and to monitor patients for symptoms of orthostatic hypotension 6.
- The use of bunazosin retard instead of prazosin retard may also help reduce the symptoms of orthostatic hypotension 6.
- It is essential to note that the management of orthostatic hypertension may require a different approach than the management of orthostatic hypotension, and more research is needed to determine the best course of treatment.
- The provided studies do not directly address the management of orthostatic hypertension, and therefore, the information provided is based on the management of orthostatic hypotension and hypertension in general.