Short-Term Effects of Antihypertensive Drugs on Postural Balance and Fall Risk

Official title

The Effect of Antihypertensive Medication Use on Fall Risk: A Randomized Controlled Trial

Overview

The goal of this clinical trial is to compare the short-term effects of three commonly prescribed antihypertensive drug classes (beta-blockers, ACE inhibitors, and calcium channel blockers) on postural balance and fall risk in adults with newly diagnosed primary hypertension. The main questions it aims to answer are: * Do different antihypertensive drugs affect objective balance performance and fall risk? * What are the effects of these medications on dizziness and fear of falling? Researchers will use a balance analysis system (Biodex Balance System) and self-reported scales (Dizziness Handicap Inventory and Falls Efficacy Scale) to assess outcomes. Participants will: * Be randomly assigned to one of three drug groups (metoprolol, ramipril, or amlodipine) * Be evaluated at baseline (prior to treatment), at 2 weeks, and at 4 weeks after starting treatment * Complete balance tests and questionnaires at each time point This study aims to provide clinical insight into how commonly used blood pressure medications may impact balance and fall risk in real-world settings.

Detailed description

Falls and balance impairments are significant health concerns, particularly in individuals with hypertension who may be starting pharmacological treatment. Some antihypertensive drugs are known to cause side effects such as dizziness, postural hypotension, and impaired balance, all of which can increase fall risk. Despite this, comparative evidence on the short-term impact of different antihypertensive drug classes on postural balance remains limited.

This randomized controlled trial aims to compare the effects of three first-line antihypertensive drug classes-beta-blockers (e.g., metoprolol), ACE inhibitors (e.g., ramipril), and calcium channel blockers (e.g., amlodipine)-on postural stability and fall risk during the initial four weeks of treatment. Participants will be individuals aged 18-75 years who have been newly diagnosed with primary hypertension and have not previously used antihypertensive medications.

Assessments will be conducted using both objective and subjective measures. Objective balance evaluations will be performed using the Biodex Balance System, including the Fall Risk Test, Postural Stability Test (overall, anterior-posterior, and medial-lateral stability indices), and the Clinical Test of Sensory Interaction on Balance (CTSIB). Subjective assessments will include the Falls Efficacy Scale (FES) to evaluate fear of falling and the Dizziness Handicap Inventory (DHI) to assess the impact of dizziness on daily life.

The trial will include three evaluation time points: baseline (before starting treatment), week 2, and week 4. By providing a multidimensional assessment of balance performance, the study seeks to identify potential safety concerns and guide clinicians in making informed treatment decisions based on both cardiovascular and postural health.

Interventions

• Drug Beta Blocker
  Participants in this group will receive standard antihypertensive treatment with a beta-adrenergic receptor blocker. The exact agent and dosage will be determined by the cardiology clinic according to clinical guidelines. Balance and fall risk assessments will be conducted at baseline (T0), week 2 (T1), and week 4 (T2).
• Drug ACE inhibitor
  Participants in this group will receive standard antihypertensive treatment with an angiotensin-converting enzyme inhibitor. The dose and specific agent will be prescribed based on routine clinical criteria. Assessments will take place at T0, T1, and T2.
• Drug Calcium channel blocker
  This group will receive a calcium channel blocker as part of their standard hypertension management. Dosage and agent will follow standard cardiology practice. Postural balance and fall risk will be measured at all study time points.

Primary outcome measures

• Fall Risk Score (Biodex Balance System) [Time frame: Baseline (T0), Week 2 (T1), Week 4 (T2)]

Secondary outcome measures (4)

• Postural Stability Indices (OSI, APSI, MLSI) [Time frame: Baseline (T0), Week 2 (T1), Week 4 (T2)]
• Sensory Integration Scores (CTSIB) [Time frame: Baseline (T0), Week 2 (T1), Week 4 (T2)]
• Falls Efficacy Scale (FES) Score [Time frame: Baseline (T0), Week 2 (T1), Week 4 (T2)]
• Dizziness Handicap Inventory (DHI) - Total and Subscale Scores [Time frame: Baseline (T0), Week 2 (T1), Week 4 (T2)]

Eligibility criteria

Inclusion criteria

• Aged between 18 and 75 years
• Newly diagnosed with primary hypertension
• No prior use of antihypertensive medication
• No history of neurological, vestibular, orthopedic, or psychiatric conditions affecting balance
• Able to walk independently without assistive devices
• Provided written informed consent to participate in the study

Exclusion criteria

• Secondary hypertension
• Known diagnosis of vestibular disorders (e.g., BPPV, Ménière's disease)
• Use of medications that may affect balance (e.g., sedatives, psychotropic drugs)
• History of falls due to trauma unrelated to balance
• Cognitive impairment preventing proper test participation
• Inability to complete the assessments at follow-up timepoints (2nd and 4th week)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Bolu Abant Izzet Baysal University, Izzet Baysal Training and Research Hospital — Bolu

Identifiers

NCT: NCT07099677 · AIBU-FTR-AO-05

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗