The association between orthostatic hypotension
and medication use in the British Women’s Heart
and Health Study
SHAHRUL KAMARUZZAMAN1,2, HILARY WATT3, CLAIRE CARSON1, SHAH EBRAHIM1
1Non-Communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene
and Tropical Medicine, London, UK
2Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
3Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine,
London, UK
Address correspondence to: S. Kamaruzzaman. Email: shahrul.kamaruzzaman@lshtm.ac.uk

Abstract
Objective: to determine the prevalence of orthostatic hypotension (OH) and associations with medication use in communitydwelling older women.
Design: cross-sectional analysis using data from the British Women’s Heart and Health Study.
Setting: general practices in 23 towns in the UK.
Participants: 3,775 women aged 60–80 years from 1999 to 2001.
Main outcome measure: orthostatic hypotension—drop of ≥20mmHg in systolic and/or a drop of ≥10mmHg in diastolic blood pressure on standing.
Results: prevalence of OH was 28% (95% confidence interval [CI] 26.6, 29.4), which increased with age and hypertension. Regardless of treatment status or diagnosed hypertension, raised blood pressure was strongly associated with OH (P < 0.001). OH was strongly associated with number of antihypertensives taken (none vs three or more: odds ratio [OR] 2.24, 95% CI 1.47–3.40, P < 0.001); the association was slightly attenuated after allowing for age and co-morbidities (OR 1.99; 95% CI
1.30, 3.05; P = 0.003). Women with multiple co-morbidities had markedly increased odds of OH independent of age, number and type of medications taken (none vs four or more diagnoses: OR 2.28, 95% CI 1.58–3.30, P = 0.005).
Conclusion: 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.

Age and Ageing 2010; 39: 51–56

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