Bhanu, Cini;
(2023)
Drug-induced postural hypotension: understanding risk of medications and their cumulative burden in older adults.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: Over 250 medications cause postural hypotension (PH). There is limited evidence on which drugs and drug combinations are associated with highest risk. Aims: To identify which drugs are associated with PH. In older adults in primary care: to examine incidence of PH; describe clusters of co-prescriptions associated with PH; and determine the association between potentially harmful drugs (and drug combinations) and PH. Methods: Systematic review of randomised controlled trials. Three epidemiological studies using IQVIA Medical Research Data (IMRD): cohort study on PH incidence; cluster analysis on co-prescriptions associated with PH; self-controlled case series on high-risk drug combinations and risk of PH. Results: Compared with placebo, drugs causing sympathetic inhibition (beta-blockers, TCAs) were associated with increased odds of PH (OR 7.76 [95% CI 2.51, 24.03]; OR 6.30 [95% CI 2.86, 13.91]). No significant difference was seen with drugs causing vasodilation. Incidence of recorded PH in people aged ≥50 was low: 17.9 cases per 10,000 person-years at risk in men (95% CI 17.6-18.2) and 16.2 cases per 10,000 PYAR in women (95% CI 15.9-16.5), increasing with age and social deprivation. Drug clusters associated with PH included: combinations of antihypertensives; antihypertensives + antidepressants; antihypertensives + uroselective alpha-blockers. I found an increased risk of incident PH with initiation of SSRIs (IRR 4.04, 95% CI: 3.39-4.81), beta-blockers (IRR 3.69, 95% CI 2.98-4.56), and TCAs (IRR 2.21, 95% CI: 1.73-2.83) compared to no drug exposure in older people. There was a cumulative effect with drug combinations initiated within 56 days of each other, most pronounced when combining two different mechanisms of action: beta-blockers and SSRIs (IRR 8.49, 95% CI 4.19-17.21) compared to no drug exposure. Conclusion: Common drug combinations (beta-blockers and antidepressants) with different mechanisms of action (e.g. sympathetic inhibition plus vasodilation) have a striking additive risk of drug-induced PH within eight weeks of initiation in older adults.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Drug-induced postural hypotension: understanding risk of medications and their cumulative burden in older adults |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10178138 |
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