Dept. of Geriatric Medicine, Gelre Ziekenhuizen, Apeldoorn & Zutphen, Zutphen, The Netherlands.
Centre of Excellence for Old Age Medicine, Gelre ziekenhuizen, Apeldoorn & Zutphen, Zutphen, The Netherlands.
J Clin Pharm Ther. 2022 Oct;47(10):1698-1703. doi: 10.1111/jcpt.13726. Epub 2022 Jul 1.
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.
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.
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]).
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.
α-阻滞剂与体位性低血压（OH）有关。我们旨在评估使用α-阻滞剂治疗下尿路症状（LUTS）的老年男性门诊患者使用逐搏血压监测测量的 OH 的患病率。此外，我们还研究了 OH 与α-阻滞剂使用时间、伴随药物使用和合并症的关系。
在泌尿科门诊进行横断面探索性研究。纳入使用α-阻滞剂治疗 LUTS 的年龄≥65 岁的白人男性。使用经过验证的逐搏血压设备（Finapres）记录从仰卧位站起来时的血压反应。从逐搏数据中得出患病率，以包括 60-110 秒之间的 OH（OH）、40 秒时的 OH 恢复受损（OH[40]）、初始 OH（IOH）和正常直立反应。根据 α-阻滞剂使用时间、多药治疗和 Charlson 合并症指数（CCI）定义亚组，以获得相对风险。
共纳入 65 例患者。中位年龄为 75 岁（范围 65-92 岁）。OH 的患病率为 7.7%（n=5）。OH[40]的患病率为 16.9%（n=11），IOH 的患病率为 38.5%（n=25）。36 例患者（55.4%）具有正常的直立反应。使用 10 种药物的亚组（n=13）的 OH 相对风险为 6.0（95%CI 1.1-32.3）。对于合并症较多（CCI≥3，n=11）的亚组，这一数字为 7.4（95%CI 1.4-39.0）。α-阻滞剂使用时间较短（<3 个月）并未增加 OH 风险（RR 0.6[95%CI 0.1-5.1]）。
OH 的总体患病率较低，与年龄匹配人群的患病率相当，这表明α-阻滞剂对 OH 的相对贡献较小。然而，在合并症较多或多药治疗的患者中，OH 风险显著增加。对于这些患者，应权衡开始使用α-阻滞剂治疗 LUTS 的益处与 OH 风险增加的情况。
