Delving deeper into beta-blocker risks

A specific type of beta-blocker has been found to increase fall risk in older people

While beta-blocker use has been associated with fall risk in some studies, the literature is contradictory.

Dutch researchers have used data from two prospective studies – including more than 10,000 people aged ≥55 years – to see whether use of beta blockers was linked to increased fall risk.

The first study was a population-based cohort spanning 1991 to 2010 (Rotterdam Study), while the second was a multi-centre, randomised, placebo-controlled, double-blind trial that ran from 2008 to 2013 (B-PROOF).

Across the sample, a total 2,917 participants encountered a fall during the follow-up time.

Meta-analysis found that use of a non-selective beta blocker was associated with increased fall risk, HR=1.22 (95%CI 1.01; 1.48).

Meanwhile, use of selective beta blocker was not associated with fall risk, HR=0.92 (95%CI 0.83; 1.01).

In both studies, use of any beta blocker was not associated with fall risk compared to non-use.

Beta-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were also not associated with fall risk.

And the results, published in the British Journal of Clinical Pharmacology, indicated no association with fall risk for past use of selective or non-selective beta blockers.

“Our study indicates an increased fall risk in older people during the use of non-selective beta blockers, contrary to selective beta blockers,” say the authors from the Erasmus University Medical Centre Rotterdam in the Netherlands.

“Fall risk should be considered when prescribing and beta blocker in this age group, and the pros and cons for beta-blockers classes should be taken into consideration,” they conclude.

“Drug-related falls remain under-recognised, leading to preventable falls and related injury,” says senior author Dr Nathalie van der Velde.

“Precise prediction of drug-related fall risk is of major importance for clinical decision-making.

“Knowledge of type-specific effects such as selectivity in beta-blockers can be expected to improve decision-making,” she says.

The findings come out soon after an MJA cohort study found falls are behind the vast majority of external-cause deaths among Australian nursing home residents.

Dr Harvey Lander, a Director at the Clinical Excellence Commission (which provides leadership for the NSW Falls Prevention Network) told the AJP that pharmacists, whether in the community, in hospitals and working with aged care facilities, are in a “unique” position to help reduce the risk of falls.

“There’s quite a number of medicines which increase a person’s risk of falling: antipsychotics, antidepressants, sedatives, opiates and other drug classes as well: anything that affects balance,” he says.

“And obviously people who are on multiple medicines are at a particularly high risk: four or more, or a combination of drugs that individually increase falls risk.

“Pharmacists who provide services to residential aged care facilities are in a unique position to identify those who are at risk, and to work together with GPs and nursing home staff in reducing that risk through optimising appropriate use of medicines and highlighting risks in order to ensure preventive measures are put in place.”

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