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- Title
Orthostatic blood pressure recovery in older males using alpha‐blockers for lower urinary tract symptoms, an explorative study in a urology outpatient clinic.
- Authors
Spies, Petra E.; Beune, Thimpe N. N.; Heesakkers, John; van Munster, Barbara C.; Claassen, Jurgen A. H. R.
- Abstract
What is known and objective: Alpha‐blockers have been associated with orthostatic hypotension (OH). We aimed to assess the prevalence of OH measured with beat‐to‐beat blood pressure monitoring in older male outpatients who used alpha‐blockers for lower urinary tract symptoms (LUTS). In addition, we investigated associations of OH with duration of alpha‐blocker use, concomitant medication use and comorbidity. Methods: Cross‐sectional explorative study in a urology outpatient clinic. Older white males ≥65 years using alpha‐blockers for LUTS were included. Blood pressure responses to standing up from supine were recorded using a validated beat‐to‐beat blood pressure device (Finapres). Prevalence rates were derived from the beat‐to‐beat data to include OH measured between 60–110 s (OH), impaired recovery OH at 40 s (OH[40]), initial OH (IOH) and normal orthostatic response. Subgroups were defined based on duration of alpha‐blocker use, polypharmacy, and Charlson comorbidity index (CCI), to obtain relative risks. Results and discussion: Sixty‐five patients were included. Median age was 75 years (range 65–92). The prevalence of OH was 7.7% (n = 5). The prevalence of OH(40) was 16.9% (n = 11) and of IOH 38.5% (n = 25). Thirty‐six patients (55.4%) had a normal orthostatic response. The relative risk of OH for the subgroup using ≥ 10 medications (n = 13) was 6.0 (95%CI 1.1–32.3). For the subgroup with multimorbidity (CCI ≥3, n = 11) this was 7.4 (95%CI 1.4–39.0). Recent initiation of alpha‐blocker use (<3 months) did not increase OH risk (RR 0.6 [95%CI 0.1–5.1]). What is new and conclusion: The overall prevalence of OH was low and comparable to age‐matched population prevalence, suggesting that the relative contribution of alpha‐blockers to OH was small. However, OH risk significantly increased in patients with multimorbidity or polypharmacy. For these patients, the benefits of starting alpha‐blockers for LUTS should be weighed against the increased risk of OH.
- Subjects
ADRENERGIC alpha blockers; RESEARCH; RELATIVE medical risk; MEN'S health; CONFIDENCE intervals; CONVALESCENCE; URINARY tract infections; CROSS-sectional method; STANDING position; POLYPHARMACY; ORTHOSTATIC hypotension; TREATMENT duration; BLOOD pressure testing machines; RISK assessment; AMBULATORY blood pressure monitoring; DESCRIPTIVE statistics; WHITE people; UROLOGY; OUTPATIENT services in hospitals; COMORBIDITY; SUPINE position; DISEASE risk factors
- Publication
Journal of Clinical Pharmacy & Therapeutics, 2022, Vol 47, Issue 10, p1698
- ISSN
0269-4727
- Publication type
Article
- DOI
10.1111/jcpt.13726