Trazodone and Risk of Orthostatic Hypotension, Syncope and Falls in Geriatric Outpatients with Hypertension

In older adults, trazodone is frequently prescribed for anxiety and insomnia owing to its perceived greater tolerability in comparison with benzodiazepines. However, it may have hypotensive effects. The aim of this study is to investigate the effects of trazodone on orthostatic blood pressure (BP) response and risk of syncope and falls in hypertensive older adults. A longitudinal observational study involving patients ≥ 75 years was conducted in two geriatric outpatient clinics in Florence, Italy. At baseline, participants underwent a 3-min active stand test, office BP measurement and home and ambulatory BP monitoring. At follow-up, syncope and falls were recorded. Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Trazodone users showed lower office diastolic BP (71.8 versus 80.1 mmHg, p = 0.042), a greater systolic and diastolic BP reduction immediately after standing (Δsystolic T0 23.8 versus 14.3 mmHg, p = 0.037; Δdiastolic T0 8.9 versus 1.6 mmHg, p = 0.004) and a greater diastolic BP reduction after 1-min standing (Δdiastolic T1 6.5 versus 0 mmHg, p = 0.029). No differences were reported for home or ambulatory BP. Incidence of syncope and falls was 25%, with a significantly higher rate in patients receiving trazodone (58.3% versus 21.2%, p = 0.001). Trazodone use predicted syncope and falls independently of age, disability and fall history. This association was not confirmed when adjusting for dementia diagnosis. BP values were not associated with the study outcome. In older hypertensive outpatients, trazodone is associated with a greater orthostatic BP drop and may predispose them to an increased risk of syncope and falls.