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Orthostatic hypotension and deprescribing — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Orthostatic hypotension and deprescribingUSMLE Step 3

A 79-year-old man with chronic kidney disease, diabetes, and hypertension has dizziness when standing. Seated blood pressure is 132/74 mm Hg; standing blood pressure after 3 minutes is 102/62 mm Hg with pulse 88/min. Medications are chlorthalidone, amlodipine, tamsulosin, and insulin. A1c is 6.4%. Which of the following is the most appropriate next step in management?

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Correct answer: C — Review and reduce contributing medications while individualizing blood pressure and glycemic targets

Older adults with orthostatic hypotension need medication review and individualized targets. Diuretics, alpha-blockers, and tight glycemic control can contribute to falls and should be reassessed.

Reference: American Geriatrics Society Beers Criteria; ADA Standards of Care in Diabetes 2026