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Cited by 73Cardiovascular Syncope and Autonomic DisordersBlood Pressure and Hypertension StudiesHeart Rate Variability and Autonomic Control

Single agent antihypertensive therapy and orthostatic blood pressure behaviour in older adults using beat-to-beat measurements: the Irish Longitudinal Study on Ageing

Open access
Canney, Mark, O’Connell, Matthew D. L., Murphy, Catriona M., O’Leary, Neil, Little, Mark A., O’Seaghdha, Conall M., Kenny, Rose Anne·2016·PLoS ONE
DOI 10.1371/journal.pone.0146156PMC PMC4701419
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Abstract

BACKGROUND: Impaired blood pressure (BP) stabilisation after standing, defined using beat-to-beat measurements, has been shown to predict important health outcomes. We aimed to define the relationship between individual classes of antihypertensive agent and BP stabilisation among hypertensive older adults. METHODS: Cross-sectional analysis from The Irish Longitudinal Study on Ageing, a cohort study of Irish adults aged 50 years and over. Beat-to-beat BP was recorded in participants undergoing an active stand test. We defined grade 1 hypertension according to European Society of Cardiology criteria (systolic BP [SBP] 140-159 mmHg ± diastolic BP [DBP] 90-99 mmHg). Outcomes were: (i) initial orthostatic hypotension (IOH) (SBP drop ≥40 mmHg ± DBP drop ≥20 mmHg within 15 seconds [s] of standing accompanied by symptoms); (ii) sustained OH (SBP drop ≥20 mmHg ± DBP drop ≥10 mmHg from 60 to 110 s inclusive); (iii) impaired BP stabilisation (SBP drop ≥20 mmHg ± DBP drop ≥10 mmHg at any 10 s interval during the test). Outcomes were assessed using multivariable-adjusted logistic regression. RESULTS: A total of 536 hypertensive participants were receiving monotherapy with a renin-angiotensin-aldosterone-system inhibitor (n = 317, 59.1%), beta-blocker (n = 89, 16.6%), calcium channel blocker (n = 89, 16.6%) or diuretic (n = 41, 7.6%). A further 783 untreated participants met criteria for grade 1 hypertension. Beta-blockers were associated with increased odds of initial OH (OR 2.05, 95% CI 1.31-3.21) and sustained OH (OR 3.36, 95% CI 1.87-6.03) versus untreated grade 1 hypertension. Multivariable adjustment did not attenuate the results. Impaired BP stabilisation was evident at 20 s (OR 2.59, 95% CI 1.58-4.25) and persisted at 110 s (OR 2.90, 95% CI 1.64-5.11). No association was found between the other agents and any study outcome. CONCLUSION: Beta-blocker monotherapy was associated with a >2-fold increased odds of initial OH and a >3-fold increased odds of sustained OH and impaired BP stabilisation, compared to untreated grade 1 hypertension. These findings support existing literature questioning the role of beta-blockers as first line agents for essential hypertension.

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  • ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers are less likely to be associated with OH compared with beta-blockers and thiazide diuretics.

    “Angiotensin-converting enzyme inhibitors, angiotensin receptors blockers, and calcium channel blockers are less likely to be associated with OH compared with beta-blockers and thiazide diuretics. 315-318”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [317]

    The Results (Study Outcomes; page not provided) found stronger evidence of OH with beta-blockers than with RAAS blockers, and a significant difference from calcium channel blockers at two time points. But they found insufficient evidence of a difference between beta-blockers and diuretics, and did not establish the claimed comparison with thiazide diuretics. (LLM, conf=0.90)

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Authors
Canney, M., O’Connell, M. D. L., Murphy, C. M., O’Leary, N., Little, M. A., O’Seaghdha, C. M., & Kenny, R. A.
Affiliations
  • Trinity College Dublin (IE)
  • Beaumont Hospital (IE)
Corresponding author
Canney, Mark
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2016-01-05
Volume
11
Issue
1
Pages
e0146156
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0146156
PMC
PMC4701419
OpenAlex
W2225747201
Cited by
73
References
35
Citations by year
2026: 4 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 11 · 2017: 9 · 2016: 6
FWCI
11.81
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
  • Dublin City University Open Access Institutional Repository (Dublin City University) (acceptedVersion)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion, cc-by-nc-sa)
Funders
  • Atlantic Philanthropies
  • Health Research Board
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
orthostatic hypotension, antihypertensive monotherapy, older adults, hypertension, beta-blockers, renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, diuretics, beat-to-beat blood pressure, untreated hypertension, Irish Longitudinal Study on Ageing
MeSH terms
Aged, Aged, 80 and over, Aging, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Female, Humans, Hypertension, Hypotension, Orthostatic, Ireland, Longitudinal Studies, Male

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