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Drug-Induced Orthostatic Hypotension — RACP Adult Medicine MCQ

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EasyCardiologyDrug-Induced Orthostatic HypotensionRACP Adult Medicine

A 75-year-old man on multiple antihypertensives (amlodipine, perindopril, doxazosin) presents with syncope occurring immediately on standing from a chair. BP lying 145/85 mmHg, standing (3 minutes) 98/60 mmHg with symptoms. Heart rate increases from 70 to 78 bpm. What is the most likely cause of syncope?

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Correct answer: C — Orthostatic hypotension

Systolic BP drop ≥20 mmHg or diastolic drop ≥10 mmHg within 3 minutes of standing defines orthostatic hypotension. This patient has a drop of 47/25 mmHg. The blunted heart rate response (<15 bpm rise) suggests autonomic failure or drug-related cause. Doxazosin (alpha-blocker) is a common culprit. Management is medication review, compression stockings, and volume expansion.

Reference: ESC – 2018 – Syncope Guidelines; eTG Cardiovascular 2024