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Drug-induced orthostatic hypotension: A systematic review and meta-analysis of randomised controlled trials

PLoS Medicine Nov 13, 2021

Bhanu C, Nimmons D, Petersen I, et al. - Findings demonstrate significantly increased odds of orthostatic hypotension (OH) in relation to medications prescribed for common conditions (including depression, diabetes, and lower urinary tract symptoms).

  • A common occurrence of drug-induced OH has been reported, and this condition results in adverse outcomes including falls, strokes, cognitive impairment, and increased mortality.

  • Randomized controlled trials comparing a drug to placebo were analyzed in this systematic review and meta-analysis, involving 69 trials with 27,079 participants, to determine the extent to which specific medications are linked with OH.

  • Significantly elevated odds of OH were reported with drugs causing sympathetic inhibition (beta-blockers, tricyclic antidepressants, antipsychotics, alpha-blockers), while most vasodilators (calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, selective serotonin reuptake inhibitors, sodium–glucose cotransporter-2 inhibitors) were related to small nonsignificant differences in odds of OH, vs placebo.

  • Cumulative risk may be conferred by drugs targeting multiple parts of the orthostatic blood pressure (BP) reflex pathway (e.g. sympathetic inhibition, vasodilation, cardio-inhibitory effects), indicating that postural BP monitoring may be beneficial for individuals with polypharmacy.

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