%0 Thesis
%9 Doctoral
%A Bhanu, Cini
%B Primary Care and Population Health
%D 2023
%F discovery:10178138
%I UCL (University College London)
%P 335
%T Drug-induced postural hypotension: understanding risk of medications and their cumulative burden in older adults
%U https://discovery-pp.ucl.ac.uk/id/eprint/10178138/
%X 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.
%Z 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.