Single Agent Antihypertensive Therapy and Orthostatic Blood Pressure Behaviour in Older Adults Using Beat-to-Beat Measurements: The Irish Longitudinal Study on Ageing

Abstract

BackgroundImpaired blood pressure (BP) stabilisation after standing, defined using beat-to-beat measurements, has been shown to predict important health outcomes. We aimed to define the relationship between individual classes of antihypertensive agent and BP stabilisation among hypertensive older adults.MethodsCross-sectional analysis from The Irish Longitudinal Study on Ageing, a cohort study of Irish adults aged 50 years and over. Beat-to-beat BP was recorded in participants undergoing an active stand test. We defined grade 1 hypertension according to European Society of Cardiology criteria (systolic BP [SBP] 140-159mmHg ± diastolic BP [DBP] 90-99mmHg). Outcomes were: (i) initial orthostatic hypotension (IOH) (SBP drop ≥40mmHg ± DBP drop ≥20mmHg within 15 seconds [s] of standing accompanied by symptoms); (ii) sustained OH (SBP drop ≥20mmHg ± DBP drop ≥10mmHg from 60 to 110s inclusive); (iii) impaired BP stabilisation (SBP drop ≥20mmHg ± DBP drop ≥10mmHg at any 10s interval during the test). Outcomes were assessed using multivariable-adjusted logistic regression.ResultsA total of 536 hypertensive participants were receiving monotherapy with a renin-angiotensin-aldosterone-system inhibitor (n = 317, 59.1%), beta-blocker (n = 89, 16.6%), calcium channel blocker (n = 89, 16.6%) or diuretic (n = 41, 7.6%). A further 783 untreated participants met criteria for grade 1 hypertension. Beta-blockers were associated with increased odds of initial OH (OR 2.05, 95% CI 1.31–3.21) and sustained OH (OR 3.36, 95% CI 1.87–6.03) versus untreated grade 1 hypertension. Multivariable adjustment did not attenuate the results. Impaired BP stabilisation was evident at 20s (OR 2.59, 95% CI 1.58–4.25) and persisted at 110s (OR 2.90, 95% CI 1.64–5.11). No association was found between the other agents and any study outcome.ConclusionBeta-blocker monotherapy was associated with a >2-fold increased odds of initial OH and a >3-fold increased odds of sustained OH and impaired BP stabilisation, compared to untreated grade 1 hypertension. These findings support existing literature questioning the role of beta-blockers as first line agents for essential hypertension.

Orthostatic Hypotension and Therapy with an Ace Inhibitor in Hypertensive Patients

“…A large study by Irish authors looked into the effects of monotherapy for hypertension (ACE inhibitors, betablockers, calcium blockers and diuretics) on the prevalence of orthostatic hypotension in older patients with hypertension. The research showed that only monotherapy with beta-blockers was coupled with long-term and persistent orthostatic hypotension (16). A group of French authors demonstrated a higher occurrence of orthostatic hypotension with the use of diuretics and calcium blockers, while ACE inhibitors were not connected to a significant postural drop in blood pressure (17).…”

Stop vasodepressor drugs in reflex syncope: a randomised controlled trial

“…For example, other authors showed that nitrates and diuretics15 and β-blockers16 are particularly related to orthostatic hypotension and syncope in older patients. Large trials with a longer follow-up are warranted.…”

Drug-induced orthostatic hypotension

“…Частота ОГ неодинакова на фоне лечения антигипертензивными препаратами разных классов. Так, она реже возникает на фоне терапии ингибиторами АПФ, блокаторами рецепторов ангиотензина II и блокаторами кальциевых каналов по сравнению с b-адреноблокаторами и тиазидными диуретиками [54][55][56][57]. В исследование PARTAGE показано, что b-адреноблокаторы в большей степени увеличивают риск развития ОГ из-за повышенной симпатомиметической активности, тогда как среди пациентов, принимающих блокаторы рецепторов ангиотензина II, ОГ встречается реже [54].…”

“…В исследование PARTAGE показано, что b-адреноблокаторы в большей степени увеличивают риск развития ОГ из-за повышенной симпатомиметической активности, тогда как среди пациентов, принимающих блокаторы рецепторов ангиотензина II, ОГ встречается реже [54]. В исследовании TILDA [56], которое включало 4467 пациентов с ОГ, применение α-адреноблокаторов и b-адреноблокаторов, но не блокаторов кальциевых каналов, было статистически значимо взаимосвязано с наличием ОГ и усугубляло симптомы ортостаза. Кроме того, наличие этих симптомов было независимым предиктором возникновения в дальнейшем обмороков.…”