Aspiring Doctor: If a patient has been on antihypertensives for the last three years with regular follow-ups, how can it be a side effect of the drug causing hypotension now? Answer: In the context of Postural Hypotension, a patient's history of being on antihypertensives for three years with regular follow-ups does not necessarily rule out the possibility of the drugs causing hypotension now. Here's why:
Cumulative Effects: Over time, the body's response to medications can change. Prolonged use of antihypertensive drugs may lead to cumulative effects that can alter blood pressure regulation, especially with changes in body weight, kidney function, or other comorbid conditions.
Age-Related Changes: As patients age, their baroreceptor sensitivity (which helps regulate blood pressure) can decrease, making them more susceptible to postural hypotension, even if they were previously stable on the same medication.
Drug Interactions or Dosage Adjustments: The patient may have started new medications or supplements that interact with their antihypertensive drugs, or there might have been recent dosage adjustments. Even if the patient is unaware, slight changes in other medications or health status can influence the effect of antihypertensives.
Physiological Changes: There could be other physiological changes, such as reduced renal function, that alter how the drug is metabolized and excreted, leading to increased sensitivity to the medication and a higher risk of hypotension.
In summary, while the patient has been stable on antihypertensives for three years, various factors could still make her prone to postural hypotension due to the medication. It's important to assess her current clinical situation, including any new medications, changes in health status, and possible interactions.
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