Fludrocortisone in the treatment of hypotensive disorders in the elderly

Heart. 1996 Dec;76(6):507-9. doi: 10.1136/hrt.76.6.507.


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 micrograms [corrected] (72%), 50 micrograms [corrected] (27%), and 200 micrograms [corrected] (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 Hypokalaemia developed in 24% at a mean of eight months; in no case was treatment withdrawn because of hypokalaemia.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.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Depression / chemically induced
  • Drug Administration Schedule
  • Edema / chemically induced
  • Evaluation Studies as Topic
  • Fludrocortisone / adverse effects
  • Fludrocortisone / therapeutic use*
  • Heart Failure / chemically induced
  • Humans
  • Hypertension / chemically induced
  • Hypokalemia / chemically induced
  • Hypotension / drug therapy*
  • Mineralocorticoids / adverse effects
  • Mineralocorticoids / therapeutic use*
  • Time Factors


  • Mineralocorticoids
  • Fludrocortisone