Takaisin

Discontinuation of antihypertensive medication on orthostatic hypotension in elderly people with mild cognitive dysfunction

Näytönastekatsaukset
Ilona Mikkola and Marianne Riekki
16.3.2021

Level of evidence: C

Discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension.

A total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study «Moonen JE, Foster-Dingley JC, de Ruijter W ym. Eff...»1. A randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment (MMSE 21-27), using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). During a 6-week period following randomisation, the discontinuation of antihypertensive treatment in 86 patients was carried out by the participant's general practitioner (GP) according to an algorithm composed by the investigators. GPs were instructed to withdraw antihypertensive medication until a maximum increase in SBP of 20 mmHg was reached. Control group consisted of 76 patients who continued antihypertensive medication. Outcome was the absence of orthostatic hypotension at 4-month follow-up.

Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses. In intention-to-treat analyses, discontinuation of antihypertensive medication showed a 31% non-significant increased probability of recovery from orthostatic hypotension, compared with continuation (RR 1.31 (95% CI 0.92–1.87), P = 0.13). The first per-protocol analysis (restricted to those with complete or partial discontinuation) showed a significant 45% increased probability of recovery from orthostatic hypotension (RR 1.45 (95% CI 1.01–2.07), P =0.04). The second per-protocol analysis (restricted to those with complete discontinuation) showed a 60% increased probability of recovery from orthostatic hypotension (RR 1.60 (95% CI 1.10–2.31), P = 0.01).Serious adverse events, defined as death, myocardial infarction, stroke, transient ischaemic attack or any hospitalisation between randomisation and follow-up, were equally distributed among the two groups.

  • Study quality: moderate
  • Applicability: good
  • Comment: The study does not provide the proportion of multimorbid patients. However, the patients can be indirectly assumed to be multimorbid. The authors claim that ortostatism is often asymptomatic and therefore the relevance of the study outcome is unclear.

References

  1. Moonen JE, Foster-Dingley JC, de Ruijter W ym. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden. Age Ageing 2016;45:249-55 «PMID: 26758532»PubMed