A recent meta-analysis published in the British Journal of Clinical Pharmacology concluded that the use of non-selective beta-blockers, such as propranolol or carvedilol, in elderly populations is associated with increased risk of falling.

Beta-blockers are commonly used in clinical practice for their efficacy in the treatment of numerous cardiovascular conditions. The pharmacokinetic properties of beta-blockers, such as receptor selectivity, lipid solubility, intrinsic sympathetic activity (ISA), and CYP2D6 enzyme metabolism, vary among each agent within the pharmacologic class. The analysis evaluated each characteristic and concluded that selectivity was the only variable associated with increased fall risk.

The evaluation was based on 2 prospective studies (the Rotterdam Study [n=7,662] and B-PROOF [n=2,407]) of patients living in their communities, aged ≥55 years. Data was drawn from pharmacy dispensing records and patient-reported fall incidents. Of the total participants, 2,917 participants experienced a fall during follow-up. Based on this data, use of a non-selective beta-blocker was associated with a 22% increased risk of falling (95% CI 1.01, 1.48). 

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There was no increased fall risk established in patients using selective beta-blockers (HR 0.92, 95% CI 0.83, 1.01). Factors such as lipid solubility and enzyme activity were determined to not impact fall risk as well.

The authors of the study concluded that, especially in the elderly population, caution should be taken in choosing the appropriate therapy in treating cardiovascular conditions. The risks and benefits of beta-blocker therapy, especially with non-selective agents, should be taken into consideration.

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