The association between STOPPFall medication use and orthostatic hypotension in community-dwelling older people

Introduction Fall-risk-increasing drugs (FRIDs), identified by the Screening Tool of Older Persons Prescriptions in older adults with high fall risk (STOPPFall), may increase fall risk by causing orthostatic hypotension (OH). This study investigates the association between STOPPFall medication use and OH in community-dwelling older people ≥65 years using data from The Irish Longitudinal Study on Ageing (TILDA). Methods Orthostatic blood pressure (BP) was measured by active stand using a Finometer. STOPPFall medications were recorded at TILDA Waves 1 & 3. Delayed BP recovery was defined by a reduction in systolic BP (sBP) ≥20 mmHg and/or diastolic BP ≥ 10 mmHg from baseline at 30 seconds after standing, ‘any OH’ a similar BP reduction at either 30, 60, 90 or 120 seconds post-stand, and classical OH by persistent reduction in sBP at all timepoints (30–120 seconds) post-stand. Regression models assessed the association between STOPPFall medications and OH and orthostatic sBP changes. Results One STOPPFall medication was prescribed in 26.9% (403/1499) of participants; 10.6% (159/1499) were prescribed ≥2 STOPPFall medications. Prescription of ≥2 STOPPFall medications was independently associated with delayed BP recovery [odds ratio (OR) 1.88 (95% CI 1.25–2.82); P = .003], ‘any OH’ [OR 1.48 (95% CI 1.00–2.18); P = .048], and classical OH [OR 2.07 (95% CI 1.13–3.78); P = .018], and was associated with significantly lower sBP at 30- [coefficient −7.91(95% CI −10.22 to −5.60); P < .001], 60- [coefficient −5.55(95% CI −7.86 to −3.24); P < .001], 90- [coefficient −2.63(95% CI −4.95 to −0.32); P = .026], and 120 seconds [coefficient − 3.67(95% CI −5.98 to −1.36); P = .002]. Increasing STOPPFall medication at Wave 3 was associated with significantly lower sBP at 30 seconds [coefficient −3.22(95% CI −5.73 to −0.72); P = .012]. Conclusion Prescription of ≥2 STOPPFall medications was associated with significantly delayed BP recovery post-stand and OH. This highlights that rationalising STOPPFall medications is indicated in older people with OH.