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Medication-induced orthostatic hypotension — SCE Geriatric Medicine MCQ

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ModerateFallsMedication-induced orthostatic hypotensionSCE Geriatric Medicine

An 82-year-old man attends a falls clinic after three falls on standing from his chair. He has hypertension, atrial fibrillation and benign prostatic enlargement. Lying BP is 142/78 mmHg and standing BP after one minute is 104/62 mmHg; ECG shows rate-controlled AF and Hb is 126 g/L. Medication includes ramipril, bisoprolol, doxazosin, apixaban and simvastatin. Which medication should be reviewed/stopped?

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Correct answer: A — Doxazosin

The temporal association with standing and the marked postural BP drop make alpha-blocker related orthostatic hypotension the most likely reversible contributor. Doxazosin is a common falls-promoting medicine and should be reviewed before stopping anticoagulation, which protects against AF-related stroke. Beta-blocker and ACE inhibitor review may be needed later, but the alpha-blocker is the most directly implicated. Medication review is a core component of multifactorial falls assessment.

Reference: NICE CG161; STOPP/START v3; BGS falls guidance