Nonselective peripheral alpha-1 blockers are avoided in Beers Criteria due to risk of which effect?

• A. Orthostatic hypotension or bradycardia
• B. Hypertension
• C. Anaphylaxis
• D. Hyperkalemia

Answer: (A)

The main idea is that blocking alpha-1 receptors in the peripheral blood vessels leads to vasodilation and a drop in blood pressure. In older adults, the ability to compensate for this drop (with reflex vasoconstriction and heart-rate changes) is diminished, so standing up can cause a significant decrease in blood pressure—orthostatic hypotension. This can result in dizziness, lightheadedness, and falls, which Beers Criteria seeks to minimize in elderly patients. While bradycardia isn’t the typical outcome of alpha-1 blockade, the prominent risk highlighted here is orthostatic hypotension with potential injury from falls, which is why these agents are avoided in Beers Criteria. The other listed effects (hypertension, anaphylaxis, hyperkalemia) aren’t expected direct results of nonselective peripheral alpha-1 blockade.