Prise en charge des chutes répétées chez l'hypertendu âgé

Among people aged 65 years or over, two thirds have hypertension (HTA) and one third fall each year. These conditions frequently coexist in the same patient, and each carries a risk for functional decline or mortality. The majority of falls result from interactions between multiple predisposing and precipitating factors. Orthostatic hypotension is recognized as a risk factor of falling. Although antihypertensive treatment may contribute to orthostatic hypotension, data from studies suggest that the link between HTA, antihypertensive medication, orthostatic hypotension and falls is more complex than expected. The treatment of HTA is crucial for the prevention of stroke and heart failure even in the frail old person at high risk for falling, but represents in this group of patients a challenge in terms of safety and quality of life. Confirmation of the diagnosis with 24-hour ambulatory blood pressure monitoring or BP monitoring at home is important. Cautious drug prescription, with adapted blood pressure targets, avoiding too intensive treatments, is important for treatment adequacy and safety. Cardiologists must pay greater attention to fall risk in older adults with HTA in an effort to prevent falls and injurious falls.