Beta blockers and dementia

I was watching 60 minutes last night. They had a segment about the use of a beta blocker propanolol for traumatic stress syndrome lauding its ability to block the formation of traumatic memories. It was pretty interesting.

Many of the elderly I interact with are on beta blockers to control their hypertension. Often, their hypertension remains poorly controlled which fits with the studies that indicate that beta blockers are not a good prescription choice for the elderly hypertensive.  Moreover, “no trial has shown that lowering blood pressure with a beta blocker reduces the risk of a heart attack or cardiovascular event in patients with essential hypertension compared with placebo.” Thus, even where the beta blocker reduces blood pressure it does not accomplish the ultimate goal of preventing heart attack, stroke, and all-cause morbidity and mortality. “This indicates that, at present, millions of elderly hypertensive patients are needlessly exposed to the cost, inconvenience, and adverse effects of beta blockers even though they will never harvest any real benefit.”

The do seem to harvest the side effects, however.  Fatigue and nightmares are fairly common side effects of beta-blockers. Other side effects that are more rare are “confusion (especially in elderly patients)” and hallucinations (seeing, hearing, or feeling things that are not there). My mother was recently put on a beta blocker while in the hospital. When I left her one evening, she was doing fine. When I got back to the hospital the next morning, she informed me that “something was wrong with her mind.” And indeed she was disoriented and seemed to have lost her mind & memory. Both her nurse and her doctor insisted that this mental state was common in people her age subjected to the stress of being in a hospital. At our insistence they discontinued the beta blocker (toprol) and within hours her mind was clear as a bell. Her blood pressure was not affected, that is, it did not go up when the meds were discontinued. I often think that if she had not had family there, she would have deteriorated further and they probably would have diagnosed her with dementia and have started her on a bunch of other drugs.

In many elderly, short term memory is fragile and they are at risk for dementia in all its various forms. Beta blockers appear to work in traumatic stress by interfering with the person’s ability to lay down such a memory. It seems reasonable to me that taking such a drug on a continuous basis may be creating dementia in many of our elderly. There was no discussion of this potential on 60 minutes and I am not aware of any studies on the topic. But, if you know an elderly person who “seems to be losing it,” perhaps you should check and see if they are on a beta blocker. It may be the drugs and not the mind that is at fault.

Right now we are managing mom’s hypertension reasonable well with herbs (Rauwolfia being the main component for that) and she seems to be doing well.

For the study on beta blockers quoted above see:

Messwerli FH. Antihypertensive therapy: beta-blockers and diuretics — why do most physicians not always follow guidelines?

Full text available at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1312291

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