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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