Abstract
Objective: Trazodone is commonly prescribed in older adults and may have hypotensive effects due to the inhibition of alpha-adrenergic receptors. The present study aimed to investigate the effects of trazodone on blood pressure (BP) and its related risk of syncope and falls in hypertensive older adults. Design and method: A longitudinal observational study involving patients aged 75 or older was conducted at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent multidimensional geriatric assessment including office BP measurement, 3-minute active stand test (BP measurement immediately after standing [T0] and at 1 [T1] and 3 minutes [T3]), home and ambulatory BP monitoring. The composite outcome of syncope and falls was assessed at 12 months and its association with trazodone was analysed using multivariate Cox regression analysis. Results: Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Participants receiving trazodone showed lower office diastolic BP (71.8 mmHg vs. 80.1 mmHg, p=0.042) and a greater systolic and diastolic BP reduction immediately after standing (δsystolicT0 16.2 mmHg vs. 9.7 mmHg, p=0.038; δdiastolicT0 11 mmHg vs. 1.7 mmHg, p=0.003). No differences were reported as regards home and ambulatory BP. Incidence of syncope and falls at 12 months was 25%, with a significantly higher rate in patients receiving trazodone (58.3% vs. 21.2%, p=0.005). Trazodone was associated with an increased risk of syncope or falls independently of physical performance (HR 2.654, 95% CI 1.104 - 6.378). This association was not confirmed when multivariate Cox analysis was adjusted for dementia diagnosis (HR for trazodone 1.874, 95% CI 0.736 – 4.773; HR for dementia 2.556, 95% CI 1.018 – 6.419). Conclusions: In older adults with hypertension, trazodone is associated with a greater orthostatic BP drop and might increase the risk of syncope and falls.
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