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Antihypertensive overtreatment with orthostatic hypotension — SCE Geriatric Medicine MCQ

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HardMultimorbidityAntihypertensive overtreatment with orthostatic hypotensionSCE Geriatric Medicine

An 88-year-old man with type 2 diabetes, CKD3 and recurrent falls is reviewed for blood pressure. Clinic BP is 126/64 mmHg sitting and 96/54 mmHg standing; he feels faint on standing. He takes ramipril, indapamide, amlodipine and doxazosin. What is the most appropriate management?

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Correct answer: B — De-intensify antihypertensive treatment, prioritising drugs contributing to postural hypotension

Symptomatic orthostatic hypotension and falls indicate overtreatment risk despite apparently acceptable sitting BP. De-intensification, especially alpha-blocker and diuretic review, should be considered in line with individual goals and risks. Adding medication would likely worsen symptoms. The pearl is that standing BP can be more clinically relevant than seated targets in frail older adults.

Reference: NICE NG136; NICE CG161; NICE NG56