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

Aims To investigate the association between use of -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=7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged >= 55years. 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 2917 participants encountered a fall during a total follow-up time of 89529years. Meta-analysis indicated no association between use of any -blocker, compared to nonuse, and fall risk, hazard ratio (HR)=0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective beta-blocker was also not associated with fall risk, HR=0.92 (95%CI 0.83-1.01). Use of a nonselective 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 nonselective beta-blocker, contrary to selective -blockers, is associated with an increased fall risk in an older population. In clinical practice, -blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a -blocker in this age group, and the pros and cons for -blocker classes should be taken into consideration.