Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis

Annelies C. Ham, S.C. van Dijk, Karin M.A. Swart, Anke W. Enneman, Nikita L. van der Zwaluw, Elske M. Brouwer-Brolsma, Natasja M. van Schoor, M.C. Zillikens, Paul Lips, Lisette C.P.G.M. de Groot, Albert Hofman, Renger F. Witkamp, André G. Uitterlinden, Bruno H. Stricker, Nathalie van der Velde*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)

Abstract

Aims: To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Methods: Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. Results: In total 2917 participants encountered a fall during a total follow-up time of 89529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Conclusion: Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.

Original languageEnglish
Pages (from-to)2292-2302
JournalBritish Journal of Clinical Pharmacology
Volume83
Issue number10
DOIs
Publication statusPublished - 2017

Keywords

  • CYP2D6
  • Falls
  • Meta-analysis
  • β-blockers

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