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Abstract(s)
A Hipotensão Ortostática é definida como uma redução da pressão arterial sistólica igual ou superior a 20mmHg ou da pressão arterial diastólica igual ou superior a 10mmHg, nos 3 minutos após a passagem de decúbito para ortostatismo. Esta síndrome pode ter na sua génese variadas etiologias e tem uma elevada prevalência na população idosa com múltiplas comorbilidades. A presença de disautonomia (como a Diabetes Mellitus ou a Doença de Parkinson), doenças cardiovasculares, a toma de determinados fármacos ou até mesmo as alterações fisiológicas associadas à idade avançada podem predispor o desenvolvimento desta síndrome. A hipotensão ortostática é também um preditor independente do aumento de mortalidade e da incidência de doenças cardiovasculares e cerebrovasculares.
O termo polimedicação pode ter múltiplas definições, sendo comum que seja definido como o uso de “5 ou mais”, “9 ou mais” ou “10 ou mais medicamentos”. Independentemente do conceito usado, a prevalência de idosos polimedicados é cada vez mais alta.
Foi feita uma pesquisa em várias fontes bibliográficas com o objetivo de entender se existe uma relação entre a hipotensão ortostática e a polimedicação, e identificar quais os fármacos mais associados a esta síndrome.
Apesar de haver alguma inconsistência nos estudos analisados, vários deles associaram a toma de múltiplos fármacos em simultâneo ao desenvolvimento de hipotensão ortostática, principalmente em pacientes idosos com várias patologias de base. Um dos principais fatores de viés nestes resultados pode estar relacionado com o facto de não haver uma definição consensual para o termo “polimedicação”, sendo este definido de diferentes formas nos estudos analisados.
Foram identificadas várias classes de fármacos associadas a esta síndrome, como os anti-hipertensores, diuréticos, antidepressivos, antipsicóticos, agonistas dopaminérgicos e bloqueadores a-adrenérgicos. No caso de pacientes hipertensos, tanto o não-controlo da hipertensão como a sua terapêutica farmacológica podem predispor ao desenvolvimento de hipotensão ortostática. Assim, a abordagem terapêutica deve ser individualizada consoante a clínica de cada paciente.
Orthostatic Hypotension is defined as a reduction in systolic blood pressure equal or greater than 20mmHg or in diastolic blood pressure equal or greater than 10mmHg within 3 minutes after standing up from a lying or sitting position. This syndrome may have several etiologies and has a higher prevalence in the elderly with multiple comorbidities. The presence of dysautonomia (such as Diabetes Mellitus or Parkinson’s Disease), cardiovascular diseases, certain drugs or even the physiological changes associated with advanced age may predispose the development of this syndrome. Orthostatic hypotension is also an independent predictor of increased mortality and incidence of cardiovascular and cerebrovascular diseases. The concept of polypharmacy can have multiple definitions, and it is commonly defined as the use of “5 or more”, “9 or more” or “10 or more drugs”. Regardless of the definition used, its prevalence in the elderly population is increasing. A search was made in several bibliographic databases in order to investigate whether or not there is a relationship between orthostatic hypotension and polypharmacy, and to identify which drugs are most associated with this syndrome. Although there were some contradictions in the studies analyzed, several of them associated the use of multiple medications with the development of orthostatic hypotension, especially in elderly patients with various underlying pathologies. One of the main bias factors in these results may be related to the fact that there is no consensual definition for the term “polypharmacy”, which is defined differently in each article. Several classes of drugs associated with this syndrome have been identified, such as antihypertensives, diuretics, antidepressants, antipsychotics, dopaminergic agonists and a-adrenergic blockers. In the case of hypertensive patients, both the uncontrolled hypertension and its pharmacological therapy may predispose to the development of orthostatic hypotension. Thus, the management of these patients should be individualized according to the clinical findings.
Orthostatic Hypotension is defined as a reduction in systolic blood pressure equal or greater than 20mmHg or in diastolic blood pressure equal or greater than 10mmHg within 3 minutes after standing up from a lying or sitting position. This syndrome may have several etiologies and has a higher prevalence in the elderly with multiple comorbidities. The presence of dysautonomia (such as Diabetes Mellitus or Parkinson’s Disease), cardiovascular diseases, certain drugs or even the physiological changes associated with advanced age may predispose the development of this syndrome. Orthostatic hypotension is also an independent predictor of increased mortality and incidence of cardiovascular and cerebrovascular diseases. The concept of polypharmacy can have multiple definitions, and it is commonly defined as the use of “5 or more”, “9 or more” or “10 or more drugs”. Regardless of the definition used, its prevalence in the elderly population is increasing. A search was made in several bibliographic databases in order to investigate whether or not there is a relationship between orthostatic hypotension and polypharmacy, and to identify which drugs are most associated with this syndrome. Although there were some contradictions in the studies analyzed, several of them associated the use of multiple medications with the development of orthostatic hypotension, especially in elderly patients with various underlying pathologies. One of the main bias factors in these results may be related to the fact that there is no consensual definition for the term “polypharmacy”, which is defined differently in each article. Several classes of drugs associated with this syndrome have been identified, such as antihypertensives, diuretics, antidepressants, antipsychotics, dopaminergic agonists and a-adrenergic blockers. In the case of hypertensive patients, both the uncontrolled hypertension and its pharmacological therapy may predispose to the development of orthostatic hypotension. Thus, the management of these patients should be individualized according to the clinical findings.
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Keywords
Disautonomia Hipotensão Ortostática Múltiplas Comorbilidades Polimedicação