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

PLoS Medicine Dec 06, 2021

Bhanu C, Nimmons D, Petersen I, et al. - Use of medications that treat common conditions (including depression, diabetes, and lower urinary tract symptoms) was found to be linked with significantly elevated odds of orthostatic hypotension (OH). Significantly increased risk of OH was evident with drugs causing sympathetic inhibition, while most vasodilators were linked with small nonsignificant differences in odds of OH, vs placebo. Postural blood pressure (BP) monitoring may benefit persons with polypharmacy.

  • OH, defined as a fall in systolic BP of ≥20 mm Hg or diastolic BP of ≥10 mm Hg within 3 minutes of assuming an erect posture, represents a common side effect of drugs and over 250 medications are linked with OH.

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

  • Elevated odds of OH were reported in relation to use of beta-blockers and tricyclic antidepressants vs placebo (odds ratios 7.76 and 6.30, respectively).

  • Up to 2-fold increased odds of OH were noted with alpha-blockers, antipsychotics, and sodium–glucose cotransporter-2 (SGLT-2) inhibitors, vs placebo.

  • Drugs mainly resulting in vasodilation (calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, selective serotonin reuptake inhibitors, SGLT-2 inhibitors) were found to be linked with smaller differences that were not statistically significant, vs placebo.

  • A cumulative risk could be noted with drugs targeting multiple parts of the orthostatic BP reflex pathway (e.g. sympathetic inhibition, vasodilation, cardio-inhibitory effects).

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