Fludrocortisone in the treatment of hypotensive disorders in the elderly

Abstract

Objective - To evaluate tolerance of fludrocortisone in older patients with hypotensive disorders. Design - Prospective case series. Setting - Syncope clinic. Patients - 64 Consecutive patients over 65 years (mean age 80 years) with one or more hypotensive disorders (orthostatic hypotension, vasodepressor carotid sinus syncope, and/or vasodepressor neurocardiogenic syncope). Interventions - Fludrocortisone in daily doses of 100 mg (72%), 50 mg (27%), and 200 mg (one patient). Main outcome measures - Adverse events, treatment withdrawal. Results - During follow up 13 patients died of unrelated causes. Of the remainder 33% discontinued fludrocortisone at a mean of five months. Reasons for discontinuing treatment were hypertension, five; cardiac failure, four; depression, three; oedema, three; and unspecified, two. In those who continued treatment supine systolic and diastolic blood pressure did not differ significantly from baseline (follow up two to 21 months). Hypokalaemia developed in 24% at a mean of eight months; in no case was treatment withdrawn because of hypokalaemia. Conclusion - Fludrocortisone, even in low doses, is poorly tolerated in the long term in older patients with hypotensive disorders.