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

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.

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)