INFLUENCE OF ANTIHYPERTENSIVE PHARMACOTHERAPY ON ORTHOSTATIC BLOOD PRESSURE AND HEART RATE

SAIMA AZIZ; SYEDA PARVEEN FATIMA; VEMAIAH ADIMULAM; BLESSY NIHARIKA MEDE; PRASHANTH KUMAR PATNAIK

doi:10.22159/ajpcr.2025v18i12.57270

Authors

SAIMA AZIZ Department of Physiology, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India. https://orcid.org/0009-0000-5014-1141
SYEDA PARVEEN FATIMA Department of Physiology, Osmania Medical College, Hyderabad, Telangana, India.
VEMAIAH ADIMULAM Department of Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Deemed University, Wardha, Maharashtra, India
BLESSY NIHARIKA MEDE Department of Pathology, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India. https://orcid.org/0009-0003-5186-524X
PRASHANTH KUMAR PATNAIK Department of Pharmacology, RVM Institute of Medical Sciences, Siddipet, Telangana, India.

DOI:

https://doi.org/10.22159/ajpcr.2025v18i12.57270

Keywords:

Orthostatic hypotension, antihypertensive drugs, Beta-blockers, ACEI, Calcium channel blockers, Blood pressure, Heart rate

Abstract

Objectives: This study aimed to assess posture-induced variations in blood pressure (BP) and heart rate (HR) among hypertensive patients receiving different classes of antihypertensive medications and to compare these hemodynamic responses with normotensive controls.

Methods: A cross-sectional study was conducted on 100 adults, including 50 hypertensive patients and 50 age- and sex-matched normotensive controls attending a tertiary care center. The hypertensive participants were divided into four groups based on their current pharmacotherapy: Group A – angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) with or without thiazide diuretics; Group B – beta-adrenergic blockers; Group C – calcium channel blockers (CCBs); and Group D – combination therapy involving two or more of these classes. After a 10-min period of supine rest, BP and HR were recorded in supine, sitting, and standing postures at 1 and 3 min. Orthostatic hypotension (OH) was defined as a reduction in systolic BP (SBP) ≥20 mmHg, diastolic BP ≥10 mmHg, or an increase in HR >20 beats/min. Statistical analysis was performed using analysis of variance with Tukey’s post hoc test, and multivariate regression was applied to adjust for confounders such as age, sex, body mass index, dosage, and treatment duration.

Results: Participants on beta-blockers (Group B) exhibited the greatest postural SBP fall (−22±6 mmHg, p<0.001) and a blunted HR rise (+6±2 bpm). Moderate changes were seen with ACEI/ARB±diuretic therapy (−14±5 mmHg; +12±4 bpm), while CCB users had minimal alterations (−10±4 mmHg; +9±3 bpm). The prevalence of OH was 32% in Group B, 20% in Group A, 14% in Group C, and 4% among controls.

Conclusion: The antihypertensive drug class markedly affects orthostatic cardiovascular responses. Beta-blockers confer the highest risk of OH, followed by ACEI/ARB-based regimens, whereas CCBs show minimal impact. Tailored drug selection, cautious dose titration, and patient counseling can reduce postural BP fluctuations and enhance treatment safety.

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Author Biography

SYEDA PARVEEN FATIMA, Department of Physiology, Osmania Medical College, Hyderabad, Telangana, India.

Assistant Professor, Department of Physiology, Osmania Medical College, Koti, Hyderabad, Telangana, India 500001

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