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

Abstract

Aims

To investigate the association between use of beta-blockers and beta-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=7,662 (the Rotterdam Study) and 2,407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying beta-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between beta-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 2,917 participants encountered a fall during a total follow-up time of 89,529 years. Meta-analysis indicated no association between use of any beta-blocker, compared to non-use, and fall risk, HR=0.97 (95%CI 0.88; 1.06). Neither was use of a selective beta-blocker associated with fall risk, HR=0.92 (95%CI 0.83; 1.01). Use of a non-selective beta-blocker was associated with an increased fall risk, HR=1.22 (95%CI 1.01; 1.48). Other beta-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk.

Conclusion

Our study suggests that use of a non-selective beta-blocker, contrary to selective beta-blockers, is associated with an increased fall risk in an older population. In clinical practice, beta-blockers have been shown effective for a variety of cardiovascular indications. Though, fall risk should be considered when prescribing a beta-blocker in this age group, and the pros and cons for beta-blockers classes should be taken into consideration.

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