Central alpha agonists such as clonidine are inappropriate for hypertension in older adults due to risk of CNS effects and bradycardia. Which statement reflects this guidance?

• A. Central alpha agonists are recommended as first-line therapy
• B. Clonidine should be avoided as first-line due to CNS effects and bradycardia
• C. Clonidine is preferred for orthostatic hypotension
• D. Guanfacine is the only recommended central agonist

Answer: (B)

Central alpha-2 agonists like clonidine are avoided as first-line therapy for hypertension in older adults because their adverse effects are more problematic in this population. The main concerns are CNS effects—sedation, confusion, delirium, and cognitive impairment—that can impair daily functioning and raise fall risk. They also can cause bradycardia and orthostatic hypotension, further increasing the risk of dizziness and falls. Because these risks outweigh the benefits when safer alternatives exist, the Beers Criteria recommends not using clonidine as initial therapy for hypertension in older adults. In practice, these drugs might be considered only after other options have been tried or in special situations with close monitoring. The other statements don’t fit this guidance: one asserts it as first-line, which isn’t recommended; another wrongly implies it helps with orthostatic hypotension; and another incorrectly claims guanfacine is the only central agonist recommended.