Antihypertensive Medications Linked to Increased Fall Risk

According to a new study, the use of medications designed to control blood pressure is associated with an increased risk of serious fall injuries, particularly among those who have previously sustained injuries in falls.

A team of investigators including researchers from Yale School of Medicine and Oregon State University sought to determine whether antihypertensive medication use was connected with experiencing a serious fall injury in a nationally representative sample of older adults.

The group conducted a competing risk analysis, as performed with propensity score adjustment and matching in the nationally representative Medicare Current Beneficiary Survey cohort, during a 3-year follow-up through 2009. Participants included 4,961 community-living adults older than 70 years, with hypertension. Antihypertensive medication intensity was based on the standardized daily dose for each antihypertensive medication class that participants used.

Among the participants, 14.1 percent received no antihypertensive medications, while 54.6 percent were in the moderate-intensity group, and 31.3 percent were in the high-intensity antihypertensive group. During follow-up, 446 participants experienced serious fall injuries, and 837 died, the study authors noted. Although the difference in adjusted hazard ratios across the groups did not reach statistical significance, results were similar in the propensity score–matched subcohort. Among 503 participants with a previous fall injury, the adjusted hazard ratios were 2.17 for the moderate-intensity group, and 2.31 for the high-intensity antihypertensive groups.

Based on these results, investigators determined that antihypertensive medications were indeed associated with an increased risk of serious fall injuries, with that connection appearing to be stronger in patients with previous fall injuries. The authors note that “the potential harms and benefits of antihypertensive medications should be weighed in deciding to continue treatment with antihypertensive medications in older adults with multiple chronic conditions.”

For primary care practitioners, these findings should signify that managing blood pressure in older patients requires careful consideration of the adverse effects, “especially considering that there is minimal evidence of strict control of blood pressure,” says David S. H. Lee, PharmD, PhD, assistant professor in the department of pharmacy practice at Oregon State University, and a co-author of the study.

“Thus, primary care physicians and patients at high risk for a fall injury should understand the goals of care,” continues Lee. “People at high risk for a fall include a prior fall injury, 2 or more non-injurious falls in the last year, or difficulty with balance or [walking]. The trade-offs of uncertain cardiovascular and fall injuries should be considered when discussing continuing treatment for hypertension.”

—Mark McGraw

Reference

Tinetti M, Han L, et al. Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults. JAMA Internal Medicine. 2014.