# DRUG-RELATED HYPOTENSION IN THE AGED WITH HEART DISEASE

> **NIH NIH R01** · HEBREW REHABILITATION CENTER FOR AGED · 1993 · $155,317

## Abstract

Our previous investigations have shown that many elderly people develop
falls and syncope due to the hypotensive effects of nitrate medications
taken for coronary artery disease (CAD).  Furthermore, some elderly people
develop profound blood pressure reduction in response to nitroglycerine,
while others do not.  Pilot data from our laboratory show a relationship
between impaired diastolic filling of the heart and a hypotensive response
to preload reduction during upright posture.  Therefore, we hypothesize the
following:  1) Elderly people with impaired diastolic function who take
nitrate medications are particularly susceptible to hypotension, due to the
preload-reducing effects of this class of drugs.  2) Further reduction in
preload due to diuretics, orthostasis, or meal digestion may compound the
risk of hypotension.  3) Calcium-channel blockers which have less of an
effect on cardiac preload may be a safer alternative for the treatment of
coronary artery disease in these people.

To test these hypotheses we propose a 3-part study of cardiovascular
responses to orthostasis and a meal, in defined groups of elderly CAD
patients taking either isosorbide dinitrate, with or without a diuretic;
diltiazem, with or without a diuretic; a diuretic alone; or no medication.
Doppler echocardiography will be used to characterize baseline diastolic
function.  In Part I, blood pressure (BP), heart rate (HR), stroke volume
(by impedance cardiography), systemic vascular resistance, forearm vascular
resistance, and venous tone will be measured supine and during 60 degree
head-up tilt, then BP and HR will be determined before and after a meal.
In Part II, subjects with 20 mm Hg or greater systolic BP declines in
response to these stimuli, will be switched to alternate medication
regimens (e.g., discontinue isosorbide and begin diltiazem or D/C all
medications), then rechallenged with repeated tilt and meal studies.  In
part III, unmedicated controls with and without CAD will be randomized to
sequential 2 week double-blind treatments with isosorbide, diltiazem, or
placebo, then cardiovascular responses to tilt and a meal on each of these
regimens will be compared.  Multivariate analyses will be performed to
determine clinical, echocardiographic, and hemodynamic variables associated
with the development of nitrate-induced hypotension.

## Key facts

- **NIH application ID:** 3121392
- **Project number:** 5R01AG009538-02
- **Recipient organization:** HEBREW REHABILITATION CENTER FOR AGED
- **SAM.gov UEI:** WS29EMGEVEJ4
- **Principal Investigator:** LEWIS LIPSITZ
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 1993
- **Award amount:** $155,317
- **Award type:** 5
- **Project period:** 1992-09-28 → 1996-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/3121392

## Citation

> US National Institutes of Health, RePORTER application 3121392, DRUG-RELATED HYPOTENSION IN THE AGED WITH HEART DISEASE (5R01AG009538-02). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/3121392. Licensed CC0.

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