Trazodone and Risk of Orthostatic Hypotension, Syncope and Falls in Geriatric Outpatients with Hypertension.

IF 3.4 3区医学 Q2 GERIATRICS & GERONTOLOGY

Drugs & Aging Pub Date : 2025-03-11 DOI:10.1007/s40266-025-01196-3

Giulia Rivasi, Marco Capacci, Lorenzo Maria Del Re, Ilaria Ambrosino, Ludovica Ceolin, Alessandra Liccardo, Maria Francesca Bisignano, Giuseppe D'Ambrosio, Greta Ceccarelli, Giulia Matteucci, Enrico Mossello, Andrea Ungar

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引用次数: 0

Abstract

Introduction: In older adults, trazodone is frequently prescribed for anxiety and insomnia owing to its perceived greater tolerability in comparison with benzodiazepines. However, it may have hypotensive effects.

Aim: The aim of this study is to investigate the effects of trazodone on orthostatic blood pressure (BP) response and risk of syncope and falls in hypertensive older adults.

Patients and methods: A longitudinal observational study involving patients ≥ 75 years was conducted in two geriatric outpatient clinics in Florence, Italy. At baseline, participants underwent a 3-min active stand test, office BP measurement and home and ambulatory BP monitoring. At follow-up, syncope and falls were recorded.

Results: Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Trazodone users showed lower office diastolic BP (71.8 versus 80.1 mmHg, p = 0.042), a greater systolic and diastolic BP reduction immediately after standing (Δsystolic_T0 23.8 versus 14.3 mmHg, p = 0.037; Δdiastolic_T0 8.9 versus 1.6 mmHg, p = 0.004) and a greater diastolic BP reduction after 1-min standing (Δdiastolic_T1 6.5 versus 0 mmHg, p = 0.029). No differences were reported for home or ambulatory BP. Incidence of syncope and falls was 25%, with a significantly higher rate in patients receiving trazodone (58.3% versus 21.2%, p = 0.001). Trazodone use predicted syncope and falls independently of age, disability and fall history. This association was not confirmed when adjusting for dementia diagnosis. BP values were not associated with the study outcome.

Conclusions: In older hypertensive outpatients, trazodone is associated with a greater orthostatic BP drop and may predispose them to an increased risk of syncope and falls.

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来源期刊

Drugs & Aging 医学-老年医学

CiteScore

5.50

自引率

7.10%

发文量

审稿时长

6-12 weeks

期刊介绍： Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.