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Ushakova S.E., Aleksandrov M.V., Paykova A.S.
Disorders of blood pressure in orthostasis in patients of older age groups receiving antihypertensive therapy
Ivanovo State Medical Academy, Ivanovo, Russian Federation

Vestnik VGMU. 2020;19(1):36-44.

Objectives. To assess the incidence of orthostatic hypotension and hypertension in elderly and senile patients with arterial hypertension (AH) receiving hypotensive therapy and the effect of orthostatic disorders on the risk of falls.
Material and methods. We examined 146 patients aged from 67 to 95 years (mean age 78.9±13.4 years), in whom arterial hypertension was diagnosed. All patients were divided into 3 groups depending on their age: the first group included 48 people aged from 65 to 74 years (mean age 70.2±3.1 years); the second group consisted of 93 patients aged from 75 to 90 years (mean age 82.8±4.3 years) and the third group was composed of 5 patients over 90 years (mean age 92.4±0.9 years). To identify the peculiarities of the hypertension course, the state of target organs, the level of blood pressure achieved against the background of antihypertensive therapy, the presence of concomitant pathology, the incidence of orthostatic hypotension and orthostatic hypertension according to the orthostatic test were taken into account.
All patients underwent a short battery of physical functioning tests that included three tests: balance assessment («keep balance in the «feet together» position», «keep balance in the semi-tandem position», «keep balance in the tandem step position»), walking speed at a distance of 4 meters and a fivefold rise from a chair without the help of their hands.
Results. As a result of the clinical examination made, geriatric polymorbidity syndrome was revealed in patients of all age groups. According to the complex of functional tests, a high risk of falls was detected in 87.2% of the examined persons. Orthostatic hypotension was found in 68.5% of patients, it being accompanied by dizziness and imbalance in 34.2% of persons. In another 30.8% of the patients arterial pressure in orthostasis decreased by less than 20 mmHg, however, dizziness was also noted in 8.2% of persons.
Conclusions. In patients of older age groups, it is necessary to conduct an orthostatic test both before antihypertensive therapy and against the background of it. When detecting orthostatic hypotension, the time of administration should be adjusted and, if necessary, the dosage of antihypertensive drugs should be reduced.
Key words: elderly and senile patients, arterial hypertension, orthostatic hypotension, risk of falls.

The study was supported by the Russian Foundation for Fundamental Research grant No.18-415-370007.


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Information about authors:
Ushakova S.E. – Doctor of Medical Sciences, head of the Chair of Outpatient Therapy and Endocrinology, Ivanovo State Medical Academy;
Aleksandrov M.V. – Candidate of Medical Sciences, associate professor of the Chair of Outpatient Therapy and Endocrinology, Ivanovo State Medical Academy;
Paykova A.S. – lecturer of the Chair of Outpatient Therapy and Endocrinology, Ivanovo State Medical Academy.

Correspondence address: Russian Federation, 153012, Ivanovo Region, Ivanovo, 8 Sheremetevskiy ave, Ivanovo State Medical Academy. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Mikhail V. Aleksandrov.

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