Adverse effects of antihypertensive medications
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Common Adverse Effects of Antihypertensive Medications
Antihypertensive medications are widely used to lower blood pressure and reduce the risk of cardiovascular disease, but they are also associated with a range of adverse effects. The most frequently reported adverse events include hypotension, syncope (fainting), acute kidney injury, electrolyte abnormalities (such as hyperkalaemia and hypokalaemia), gout, and falls. The risk of these events is generally low in the overall population but increases significantly in older adults, those with frailty, and individuals with a previous history of similar adverse events Albasri20212Sheppard2023.
Risk Factors and Vulnerable Populations
Older adults, especially those with frailty or impaired renal function, are at higher risk for serious adverse events from antihypertensive medications. These risks include hospitalizations or death from falls, acute kidney injury, and electrolyte disturbances. Patients with a history of adverse events are particularly vulnerable, experiencing higher rates of these complications compared to those without such a history 2Sheppard2023Alhawassi2018. Recent medication changes and a previous history of allergies or adverse drug reactions also increase the likelihood of experiencing adverse effects .
Adverse Effects by Drug Class
Different classes of antihypertensive drugs have distinct profiles of adverse effects:
- Diuretics (especially thiazide and loop diuretics) are linked to impaired glucose tolerance, dyslipidemia, and gout. These metabolic effects are dose-related and independent of body weight Suter1995Moser1990.
- Beta-blockers can cause increases in fasting blood glucose and impaired glucose tolerance. Those without intrinsic sympathomimetic activity have more adverse effects on lipid metabolism .
- ACE inhibitors and calcium channel blockers are generally metabolically neutral, with ACE inhibitors sometimes improving insulin sensitivity. They are less likely to cause metabolic disturbances compared to diuretics and beta-blockers .
- Angiotensin receptor blockers (ARBs) are associated with a lower risk of treatment discontinuation due to adverse events compared to other antihypertensive classes .
- Centrally acting drugs tend to have higher rates of annoying side effects, leading to higher discontinuation rates Moser1990Thomopoulos2016.
Impact on Medication Adherence
Adverse effects are a significant contributor to poor adherence to antihypertensive therapy. Symptoms such as tiredness, muscle pain, and poor sleep can lead patients to stop taking their medications, which in turn increases the risk of cardiovascular events due to uncontrolled blood pressure . Discontinuation rates for adverse events are higher for most antihypertensive classes compared to placebo, except for ARBs, which have a more favorable tolerability profile .
Deprescribing and Safety
In older adults with controlled blood pressure, reducing the number of antihypertensive medications (deprescribing) can be achieved without increasing the risk of serious adverse events, mortality, or cardiovascular disease over several years. This suggests that deprescribing is a safe option for selected patients, particularly those with polypharmacy and frailty .
Emergency Department Considerations
All categories of antihypertensive agents can cause adverse effects that may require emergency care, especially in vulnerable populations. Emergency departments need to be prepared to recognize and manage these adverse reactions promptly to minimize morbidity and mortality .
Conclusion
While antihypertensive medications are effective in reducing cardiovascular risk, they are associated with both mild and severe adverse effects, particularly in older adults, those with frailty, and patients with a history of adverse events. The risk of adverse effects varies by drug class, with ARBs generally being better tolerated. Adverse effects can impact medication adherence and may necessitate deprescribing in certain populations. Careful patient selection, monitoring, and shared decision-making are essential to balance the benefits and risks of antihypertensive therapy.
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