The risk of orthostatic hypotension (OH) was found to be significantly increased with a variety of medications, particularly sympathetic inhibitors, according to the findings of a systematic review and meta-analysis published in PLOS Medicine.

To assess the association between different medication classes and the risk of OH, study authors searched EMBASE, MEDLINE, and Web of Science databases to obtain randomized placebo-controlled trials (RCTs) reporting on OH as an adverse effect in adults. “Summary odds ratios (ORs) were estimated for OH using fixed effects Mantel–Haenszel statistics,” the authors explained.

The meta-analysis included 69 RCTs with a total of 27,079 patients. Results showed that the odds of OH were significantly increased with beta-blockers (OR 7.76; 95% CI, 2.51-24.03) and tricyclic antidepressants (OR 6.30; 95% CI, 2.86-13.91) when compared with placebo. Findings also revealed that alpha-blockers, antipsychotics, and sodium–glucose cotransporter-2 (SGLT-2) inhibitors were associated with higher odds of OH vs placebo (up to a 2-fold increase).

No significant differences in OH risk were observed when vasodilators (calcium channel blockers [CCBs], angiotensin-converting enzyme [ACE] inhibitors/angiotensin receptor blockers [ARBs], selective serotonin reuptake inhibitors [SSRIs]) were compared with placebo; however, the authors noted that this may be dependent upon dose, age and comorbidities.


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“Drugs targeting multiple parts of the orthostatic blood pressure (BP) reflex pathway (eg, sympathetic inhibition, vasodilation, cardio-inhibitory effects) may carry cumulative risk, suggesting that individuals with polypharmacy could benefit from postural BP monitoring,” the authors concluded.

Reference

Bhanu C, Nimmons D, Petersen I. Drug-induced orthostatic hypotension: A systematic review and meta-analysis of randomised controlled trials. PLoS Med. Published online November 9, 2021. doi.org/10.1371/journal.pmed.1003821.