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Antidepressant use and orthostatic hypotension in older adults living with m ild‐to‐moderate Alzheimer disease
Author(s) -
Dyer Adam H,
Murphy Claire,
Briggs Robert,
Lawlor Brian,
Kennelly Sean P
Publication year - 2020
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.5377
Subject(s) - orthostatic vital signs , antidepressant , medicine , cohort , risk factor , blood pressure , hippocampus
Objectives Antidepressant use is often reported as a risk factor for Orthostatic Hypotension (OH), however this relationship has never been explored in those with mild/moderate Alzheimer Disease (AD), who may represent a particularly vulnerable cohort. Methods We performed a cross‐sectional analysis of baseline data from the NILVAD study. Participants with mild‐moderate AD were recruited from 23 centres in nine countries. Systolic and Diastolic Blood Pressure (SBP/DBP) was recorded in the seated position and after both 1 and 5 minutes of standing. OH was defined as a drop of ≥20 mmHg SBP/≥10 mmHg DBP. We examined the relationship between antidepressant use, orthostatic BP drop and the presence of OH, controlling for important covariates. Results Of 509 participants (72.9 ± 8.3 years, 61.9% female), two‐fifths (39.1%; 199/509) were prescribed a regular antidepressant. Antidepressant use was associated with a significantly greater SBP and DBP drop at 5 minutes (β: 1.83, 0.16‐3.50, P = .03 for SBP; β: 1.13, 0.02‐2.25, P < .05 for DBP). Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with a significantly greater likelihood of OH (OR 2.0, 1.1‐3.6, P = .02). Both findings persisted following robust covariate adjustment. Conclusions In older adults with AD, antidepressants were associated with a significantly greater SBP/DBP drop at 5 minutes. SSRI use in particular may be a risk factor for OH. This emphasises the need to screen older antidepressant users, and particularly those with AD, for ongoing orthostatic symptoms in order to reduce the risk of falls in this vulnerable cohort.