207 What is the association between psychotropic medication use and orthostatic hypotension in community-dwelling older people: data from TILDA

Abstract

Abstract Background Psychotropic medications increase the risk of falls among older people. The aim of this study is to examine the link between psychotropic medication use and Orthostatic Hypotension (OH), a frequent cause of falls in later life. Methods: Participants ≥65 years at TILDA Wave 1 had an active stand to assess orthostatic blood pressure. OH was defined as a blood pressure (BP) drop ≥20 mmHg systolic and/or ≥ 10 mm Hg diastolic beyond 30 seconds post-standing. Medication lists were examined for the following anatomic therapeutic chemical classification codes: N06A (Antidepressants); N05BA, N05CD, N03AE (Benzodiazepines); ‘N05CF (‘Z’ Drugs); N05A (Antipsychotics) and medications with ‘definite’ anticholinergic effects on the Anticholinergic Cognitive Burden Scale. Logistic regression models, reporting odds ratios (OR), assessed the association between psychotropic medication use and OH. Analyses were adjusted for age, sex, educational attainment, alcohol excess, depression, cognitive impairment, chronic disease burden, heart disease and sleep quality. Results Of the 1,875 participants (mean age 71 years, 52% female), 12% were prescribed ≥1 psychotropic medication (234/1,875), while 4% (78/1,875) were prescribed ≥2. Psychotropic medication use was associated with a larger drop in systolic BP at 30 seconds (7.81 (95% CI 5.61–10.02) vs 3.46 (95% CI 2.61–4.32) mm Hg; p < 0.001) and 60 seconds (4.02 (95% CI 1.82–6.21) vs 1.28 (0.44–2.13); p = 0.025) post standing. In fully adjusted models, psychotropic medication use was associated with a higher likelihood of OH (OR 1.50 (95% CI 1.10–2.08; p = 0 0.013), with a stronger association noted for those taking ≥2 psychotropics (OR 2.19 (95% CI 1.34–3.57); p = 0.002). Conclusion Psychotropic medication use is independently associated with delayed BP recovery after standing. Older people prescribed psychotropics have a 50% higher likelihood Of OH related to their use, highlighting the importance of reviewing these medications as part of a comprehensive geriatric assessment, particularly in older people with falls.