University of Florence.
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Monaldi Arch Chest Dis. 2020 Nov 20;90(4). doi: 10.4081/monaldi.2020.1254.
Orthostatic hypotension (OH) is defined as an abnormal blood pressure reduction when standing and is frequently diagnosed in older adults. Pharmacological therapy is one of the main causes of orthostatic blood pressure impairment, leading to iatrogenic OH. Indeed, several medications may induce hypotensive effects and influence the blood pressure response to orthostatism. Hypotensive medications may also overlap with other determinants of OH, thus increasing the burden of symptoms and the risk of complications. Potentially hypotensive medications include both cardiovascular and psychoactive drugs, which are frequently prescribed in older patients. According to the available evidence, the antihypertensive treatment "per se" does not seem to predispose to OH, even if a higher risk is associated with polypharmacy and drug classes such as with diuretics and vasodilators. As concerns psychoactive medications, OH is a well-known adverse effect of tricyclic antidepressants, trazodone and antipsychotics. The knowledge of hemodynamic consequences of drug therapy may be helpful to improve OH treatment. A medication review is advisable in all patients presenting with OH, particularly at advanced age, aiming at optimizing medical treatment with a view to minimize the risk of iatrogenic OH.
直立性低血压（OH）定义为站立时血压异常降低，常发生在老年人中。药物治疗是引起直立性血压损害的主要原因之一，导致医源性 OH。事实上，许多药物可能会引起低血压作用，并影响血压对直立的反应。降压药物也可能与 OH 的其他决定因素重叠，从而增加症状负担和并发症风险。潜在的降压药物包括心血管药物和精神药物，这些药物在老年患者中经常开处方。根据现有证据，降压治疗“本身”似乎不会导致 OH，即使与多药治疗和利尿剂、血管扩张剂等药物类别相关的风险更高。至于精神药物，三环类抗抑郁药、曲唑酮和抗精神病药是众所周知的 OH 不良反应。了解药物治疗对血流动力学的影响可能有助于改善 OH 的治疗。所有出现 OH 的患者，特别是高龄患者，都应进行药物审查，目的是优化医疗治疗，最大限度地降低医源性 OH 的风险。
