Medication to treat hypertension in older patients appears to be associated with an increased risk of serious injury from falling such as a hip fracture or head injury, especially in older patients who have been injured in previous falls, according to a study.
Most people older than 70 have hypertension, and blood pressure control is key to reducing risk for myocardial infarction and stroke, according to background information for the study, which was published Feb. 24 on the website of JAMA Internal Medicine. Previous research has suggested that blood pressure medications may increase risk of falls and fall-related injuries.
Mary E. Tinetti, MD, of the Yale School of Medicine in New Haven, Conn., and colleagues examined the association between BP medication use and experiencing a serious injury from a fall in 4,961 patients older than 70 with hypertension. Among the patients, 14.1% took no antihypertensive medications, 54.6% had moderate exposure to BP medications and 31.3% had high exposure.
During a three-year follow-up, 446 patients (9%) experienced serious injuries from falls. The risk of serious injuries from falls was up to 40% higher for patients who used antihypertensive medication than for nonusers and more than twice as high for patients with a previous fall injury.
Although cause and effect cannot be established in this observational study and we cannot exclude confounding, antihypertensive medications seemed to be associated with an increased risk of serious fall injury compared with no antihypertensive use in this nationally representative cohort of older adults, particularly among participants with a previous fall injury, the authors wrote.
The potential harms vs. benefits of antihypertensive medications should be weighed in deciding whether to continue antihypertensives in older adults with multiple chronic conditions.
In a related commentary, Sarah D. Berry, MD, MPH, and Douglas Kiel, MD, MPH, of Hebrew SeniorLife in Boston, wrote: These findings add evidence that antihypertensive medications are associated with an elevated risk of injurious falls.
An alternative possibility is that the increased risk of injurious falls is due not to antihypertensive medications but rather to the underlying hypertension or overall burden of illness.
So how do clinicians reconcile the potential harms and benefits of antihypertensive medications in elderly patients? In the absence of direct data, they should individualize the decision to treat hypertension according to functional status, life expectancy and preferences of care. Most important, clinicians should pay greater attention to fall risk in older adults with hypertension in an effort to prevent injurious falls, particularly among adults with a previous injury.
Study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1832197