Blood Pressure Drug Initiation Linked to Serious Falls in Elderly

Initiating antihypertensive therapy increases the short-term risk of falls in elderly patients, study finds.
Initiating antihypertensive therapy increases the short-term risk of falls in elderly patients, study finds.

Initiating or adding antihypertensive medications is associated with an increased short-term risk of serious fall injuries in elderly patients, according to new study findings.

Daichi Shimbo, MD, of Columbia University Medical Center in New York, and collaborators studied 90,127 Medicare beneficiaries aged 65 years and older who suffered a serious fall injury. Initiation of antihypertensive medication and a diagnosis of hypertension in the 365 days prior to filling a first antihypertensive medication prescription were associated with 36% increased odds of a serious fall injury within 15 days. Initiation of antihypertensive medication was associated with a significant 38% increased odds of a serious fall injury within 15 days among beneficiaries not hospitalized in the 365 days before their fall. 

For beneficiaries already on antihypertensive medication, starting a new class of medication was associated with an overall 16% increased odds of a serious fall injury; it was associated with a 15% and 20% increased odds among those with a diagnosis of hypertension and in those not hospitalized within 365 days prior to their fall, the researchers reported at the American Society of Hypertension 2015 Annual Scientific Meeting. Initiation of antihypertensive medication was not associated with increased odds of a serious fall injury beyond 15 days. 

Dr. Shimbo's group defined serious fall injuries based on emergency department and inpatient claims with an injury code for a non-pathologic fracture, brain injury, or dislocation of the hip, knee, shoulder, or jaw, along with a fall-related code, or with the requirement that there was no motor vehicle accident code in the absence of a fallrelated code. Patients were included in the study only if they had full Medicare free-for-service and pharmacy coverage. 

The study findings are consistent with those of a study published in JAMA Internal Medicine (2014;174:588-595), which found that moderate-intensity and high-intensive antihypertensive drug treatment were associated with a 40% and 28% increased risk of serious fall injuries compared with not taking antihypertensive medications. The study included 4,961 community-living hypertensive adults older 70 years. 

In a study published recently online ahead of print in Hypertension, however, researchers found that in relatively healthy elderly individuals, antihypertensive drugs were not associated with an increased risk of falls. The study, led by Lewis A. Lipsitz, MD, of the Hebrew SeniorLife Institute for Aging Research in Boston, included 598 hypertensive community-dwelling patients aged 70–97 years. Patients taking ACE inhibitors had a significant 38% decreased 1-year risk of injurious falls, and those taking calcium channel blockers had a significant 38% decreased risk of all falls and 43% decreased risk of indoor falls compared with individuals not taking these drugs, the researchers reported. In addition, higher doses of both classes of these drugs were associated with a lower fall risk.

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