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Beta-Blockers More Likely than Other Antihypertensives to Cause Orthostatic Hypotension in Elderly: Presented at AGS

By Emma Hitt

BALTIMORE, MD -- May 27, 2003 -- Beta-blockers appear to increase the risk of orthostatic hypotension compared to other types of antihypertensives, researchers report.

Heath Catoe, an undergraduate student from the University of South Carolina, in Columbia, presented the findings from a study here May 15^th at the Annual Meeting of the American Geriatrics Society. The study's second author was Sherry L. Sixta, MD, with the Department of Pathology at the University of South Carolina, in Columbia.

Almost one quarter of elderly patients may have orthostatic hypotension. Postural changes in blood pressure increase with age and are associated with an increase in morbidity and mortality, especially falls, syncope, and cardiovascular mortality, according to the researchers.

Although postural changes in blood pressure are common in elderly patients, the effects of different types of antihypertensives on this condition have not been evaluated, they note.

Catoe and colleagues collected data on 836 patients from a single academic geriatric practice. Their mean age was 76.5 years and mean body mass index 26.5; 75% were female and 87% were white.

The researchers collected blood pressure measurements while the patients were supine, sitting, or standing. Information on blood pressure medications was also collected.

Postural changes in blood pressure were measured as sit to stand and supine to stand systolic blood pressure and diastolic blood pressure. Orthostatic hypotension was defined as a decrease in blood pressure of at least 20/10 mm Hg.

Based on sitting blood pressure, 78% of patients were hypertensive and 54% were receiving antihypertensives; 55% were taking one drug, 34% were taking two, 8% were taking three, and 2% were taking more than three.

Results also show that 24% of patients had orthostatic hypotension. Patients taking beta-blockers alone or in combination had the most significant change in postural blood pressure (P=0.005). The average sit-to-stand change in blood pressure was 4.9/-0.8 mm Hg. The mean sit-to-stand change in blood pressure with beta-blockers was 11.6 mm Hg, compared to 4.0 mm Hg with diuretics, 5.5 mm Hg with angiotensin-converting enzyme inhibitors, 4.9 mm Hg with non-dihydropyridine calcium channel blockers, 2.9 mm Hg with alpha-blockers, and 6.9 mm Hg with angiotensin receptor blockers.

After multivariate analysis, the odds ratio of orthostatic hypotension in patients taking beta-blockers versus any other type of antihypertensive was 3.3 [95% CI 1.29-8.54]. None of the other classes of antihypertensives caused a significant change in postural blood pressure.

The use of any type of antihypertensive and the number of drugs used was not linked to an increase in postural changes in blood pressure or orthostatic hypotension, the researchers reported.

Multivariate analysis also found that a higher postural change in blood pressure was associated with higher sitting systolic blood pressure (P<0.001) and being African American (P=0.032).

"Beta-blockers should be used cautiously in patients with symptomatic postural changes in blood pressure or orthostatic hypotension," the researchers conclude.

"Studies have shown conflicting evidence regarding the impact of various hypertensive classes on postural changes in blood pressure," Mr. Catoe said in an interview. "Our study shows that being on antihypertensive medication is not necessarily associated with orthostatic hypotension or significant postural changes in blood pressure, expect for the use of beta-blockers," he said.


[Study title: Postural Changes in Blood Pressure and Orthostatic Hypotension in the Elderly: Comparison of Different Antihypertensive Classes. Abstract P118]

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