Initiating or addingantihypertensive medications is associatedwith an increased short-term riskof serious fall injuries in elderly patients,according to new study findings.
Daichi Shimbo, MD, of ColumbiaUniversity Medical Center in NewYork, and collaborators studied 90,127Medicare beneficiaries aged 65 years andolder who suffered a serious fall injury.Initiation of antihypertensive medicationand a diagnosis of hypertension inthe 365 days prior to filling a first antihypertensivemedication prescriptionwere associated with 36% increasedodds of a serious fall injury within 15days. Initiation of antihypertensivemedication was associated with a significant38% increased odds of a seriousfall injury within 15 days amongbeneficiaries not hospitalized in the 365days before their fall.
For beneficiaries already on antihypertensivemedication, starting a new class ofmedication was associated with an overall16% increased odds of a serious fallinjury; it was associated with a 15% and20% increased odds among those witha diagnosis of hypertension and in thosenot hospitalized within 365 days prior totheir fall, the researchers reported at theAmerican Society of Hypertension 2015Annual Scientific Meeting. Initiationof antihypertensive medication was notassociated with increased odds of a seriousfall injury beyond 15 days.
Dr. Shimbo’s group defined seriousfall injuries based on emergencydepartment and inpatient claims withan injury code for a non-pathologic fracture,brain injury, or dislocation of thehip, knee, shoulder, or jaw, along witha fall-related code, or with the requirementthat there was no motor vehicleaccident code in the absence of a fallrelatedcode. Patients were included inthe study only if they had full Medicarefree-for-service and pharmacy coverage.
The study findings are consistent withthose of a study published in JAMAInternal Medicine (2014;174:588-595),which found that moderate-intensityand high-intensive antihypertensivedrug treatment were associated with a40% and 28% increased risk of seriousfall injuries compared with not takingantihypertensive medications. Thestudy included 4,961 community-livinghypertensive adults older 70 years.
In a study published recently onlineahead of print in Hypertension, however,researchers found that in relativelyhealthy elderly individuals, antihypertensivedrugs were not associatedwith an increased risk of falls. Thestudy, led by Lewis A. Lipsitz, MD,of the Hebrew SeniorLife Institute forAging Research in Boston, included598 hypertensive community-dwellingpatients aged 70–97 years. Patients takingACE inhibitors had a significant38% decreased 1-year risk of injuriousfalls, and those taking calcium channelblockers had a significant 38%decreased risk of all falls and 43%decreased risk of indoor falls comparedwith individuals not taking thesedrugs, the researchers reported. Inaddition, higher doses of both classesof these drugs were associated with alower fall risk.