Dr Cini Bhanu | Revealing Which Medications Can Cause Postural Hypotension

Postural hypotension is common in older adults, but the exact prevalence is not currently known. This condition is particularly dangerous in older people, as it increases their risk of falling, fractures, stroke and dementia. Dr Cini Bhanu’s team at University College London and public contributors have conducted research to understand the prevalence of postural hypotension and the factors affecting it.

The team investigated the GP records of almost three million patients aged over 50, and found that around 1% had been diagnosed with postural hypotension. This value is much lower than that reported in other community studies where postural hypotension is screened for. The researchers suspect that this is likely due to a number of barriers, including patients underreporting to GPs, and under-detection in primary care. Indeed, many GPs do not screen for the condition, and up to 30% of patients do not show typical symptoms.

The team found that men are more likely than women to have postural hypotension, and that the condition increases with age and social deprivation. Postural hypotension is also a common side-effect of many medicines. However, it was previously unclear which particular groups of drugs cause postural hypotension.

To find out, Dr Bhanu and her team reviewed the findings of 69 different drug trials, which compared rates of postural hypotension in patients taking a range of different medications to those taking a placebo. They found that certain drugs prescribed for pain, mental health conditions, and insomnia are all associated with an increased risk of postural hypotension.

These medications belong to groups known as alpha-blockers, beta-blockers, anti-depressants and anti-psychotics. The drugs with the greatest risk of postural hypotension all inhibit the effects of the sympathetic nervous system, which is responsible for the ‘fight or flight’ response to stress.

The team’s research has important implications for patient care. This is the first research investigating postural hypotension in older people that reveals groups of drugs and the extent to which they can cause postural hypotension. The researchers’ findings highlight the importance of regular postural blood pressure checks for older people, particularly those who are taking multiple medications.