Titration of antihypertensive therapy to mitigate the risk of falls

Editor – I read with interest the abstract by D'Souza and Bargaoanu; during the course of the implementation of the falls service, the authors had cause to stop or decrease the dose of calcium channel blockers.¹ The necessity to make such a change in medication may arise if the precaution has not been taken to advise the patient to titrate the dose of an antihypertensive vasodilator against his home blood pressure measurement during hot weather. In the experience of Alpert, the summer months were associated with an increase in the number of patients who fainted while on vasodilator antihypertensive drugs.² For him, an ‘A-ha’ moment was when one of his patients said that she had halved her dose of enalapril during the summer months because, if she did not do so, she would not be able to get out of bed in the morning.

The most compelling reason to encourage the use of home blood measurements is to empower patients to titrate their antihypertensive medication. All patients should be made aware of a cut-off level of home systolic blood pressure, below which, they should be advised to reduce their antihypertensive medication, and to communicate that change in medication to their doctor.