Re: Withdrawing antihypertensives on the basis of orthostatic hypotension

摘要

Sir— We appreciated Dr MacMahon and colleagues’ letter commenting on our paper and the accompanying editorial [1]. We agree that there is no strong evidence on the effects on falls of withdrawing antihypertensive medication in people with postural symptoms or in those with asymptomatic orthostatic hypotension (OH). We did not conclude that OH alone should be a criterion for withdrawing antihypertensive treatment. Data from the British Women’s Heart & Health Study have shown that falls are more strongly associated with co-morbidity than with polypharmacy [2, 3]. We did show that OH was twice as prevalent in women with undiagnosed and uncontrolled high blood pressure. On the basis of the findings presented in our paper, we concluded that ‘uncontrolled hypertension, use of three or more antihypertensives and multiple co-morbidities are predictors of OH in older women. Detection or monitoring of OH in these groups may prevent women from suffering its adverse consequences’.