Dr Cini Bhanu | Revealing Which Medications Can Cause Postural Hypotension
About this episode
The Office for National Statistics has forecast that by 2040, one in seven citizens will be aged 75 or over. An aging population faces a number of healthcare challenges, including an increase in the prevalence of chronic conditions, and changes in physiology that increase the risk of falls and other accidents. Postural – or orthostatic – hypotension is a condition in which a person’s blood pressure drops significantly when they stand up from sitting or lying down. When blood pressure drops suddenly on standing, not enough blood flow reaches a person’s brain and they can experience symptoms such as dizziness, blurred vision, and falls. Read More
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.
Original Article Reference
Summary of the papers: ‘Incidence of postural hypotension recorded in UK general practice: an electronic health records study’ in British Journal of Best Practise, doi.org/10.3399/BJGP.2022.0111; and ‘Drug-induced orthostatic hypotension: A systematic review and meta-analysis of randomised controlled trials’ in PLOS Medicine, doi.org/10.1371/journal.pmed.1003821
This research was funded by The Dunhill Medical Trust [grant number RTF1906/131], and supported by the National Institute for Health and Care Research ARC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care
For further information, you can connect with Dr Cini Bhanu on Twitter @cinibhanu or at email@example.com
This work is licensed under a Creative Commons Attribution 4.0 International License.
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