Frail Older Adults with High Anticholinergic Burden are at Risk of Orthostatic Hypotension

Frailty has been shown to be linked with orthostatic hypotension (OH) in older adults, but the role of anticholinergic drugs in this relationship never has been explored. The purpose of this was to examine the relationship between anticholinergic burden (ACB) and OH in frail older adults living in the community and to examine whether this association differs according to polypharmacy.

A cross-sectional study.

Frail community-dwelling individuals aged ≥65 years admitted to the geriatric outpatient clinic (n = 399).

Frailty status was defined by having ≥3 clinical features of the Fried Frailty Index. OH was a drop of ≥20 mm Hg in systolic blood pressure or a drop of ≥10 mm Hg in diastolic blood pressure 1 or 3 min after rising from a sitting position. ACB for each participant was categorized as none (ACB = 0), low (ACB = 1), or high (ACB ≥2). Multivariate logistic regression models were implemented to examine the association of ACB with OH.

The mean age of the sample was 79.8 years and 59.9% were women; 59 (13.3%) participants had OH. Exposure to anticholinergics was present in 41.4% of the participants, polypharmacy in 48.1%, and potentially inappropriate drug use in 44.1%. Multivariate analysis yielded a statistically significant risk of high ACB-related OH in the fully adjusted model [OR: 4.14 (1.33-12.86), P = .014]. None of the interaction terms of ACB with polypharmacy were significant in any model.

In frail older people, because exposure to a high anticholinergic load may be associated with OH, special attention should be paid to anticholinergics in medical treatment to prevent a reduction in blood pressure upon standing.