Symptomatic Orthostatic Hypotension in a 66-Year-Old Man Receiving Amlodipine: A Case Report

Abstract

Background: Orthostatic hypotension is a major cause of dizziness, syncope, falls, and loss of independence in older people. The age-related changes in the cardiovascular regulation system, concomitant diseases, medications, and behavioral aspects may impair the individual’s ability to maintain the blood pressure while being in the standing position. Case Presentation: A 66-year-old man with more than 10 years of history of essential hypertension had repeated complaints of light-headedness, orthostatic dizziness, fainting with falls. The man used amlodipine 5 mg once per day with inconsistent adherence and consumed alcohol (approximately 1 L of 5.5% beer nightly). Blood pressure of the patient after 10 minutes of resting in the supine position was 124/78 mmHg with heart rate 72 bpm. Blood pressure of the man 3 minutes after active standing reduced to 88/54 mmHg with heart rate 72 bpm. It is 36 mmHg reduction in systolic blood pressure and 24 mmHg reduction in diastolic blood pressure. These changes met the diagnostic criteria for orthostatic hypotension, without any compensatory increase in heart rate. Other causes of syncope were considered during clinical assessment. The amlodipine dose was reduced from 5 mg to 2.5 mg once daily The supportive treatment and fall prevention measures were undertaken, and the patient was educated about hydration, gradual change of body position, alcohol restriction, and follow-up. At the three-week review, his dizziness had improved and no further falls were reported. Conclusion: This case highlights the importance of standardized assessment of orthostatic vital signs in elderly people with dizziness, syncope, or falls even when blood pressure in the supine position is within normal limits. Though the use of amlodipine and alcohol consumption were possible contributing factors, they cannot be considered as proven causes of orthostatic hypotension of the patient. Because several measures were introduced together, the improvement cannot be attributed to any single intervention.