Bottom Line: Medication to treat high blood pressure (BP) in older patients appears to be associated with an increased risk for serious injury from falling such as a hip fracture or head injury, especially in older patients who have been injured in previous falls.
Author: Mary E. Tinetti, M.D., of the Yale School of Medicine, New Haven, Conn., and colleagues.
Background: Most people older than 70 years have high blood pressure, and blood pressure control is key to reducing risk for myocardial infarction (MI, heart attack) and stroke. Previous research has suggested that blood pressure medications may increase risk of falls and fall injuries.
How the Study Was Conducted: Researchers examined the association between BP medication use and experiencing a serious injury from a fall in 4,961 patients older than 70 years with hypertension. Among the patients, 14.1 percent took no antihypertensive medications, 54.6 percent had moderate exposure to BP medications and 31.3 percent had high exposure.
Results: During a three-year follow-up, 446 patients (9 percent) experienced serious injuries from falls. The risk for serious injuries from falls was higher for patients who used antihypertensive medication than for nonusers and even higher for patients who had had a previous fall injury.
Conclusion: “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 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, M.D., M.P.H., and Douglas P. Kiel, M.D., M.P.H., of Hebrew SeniorLife, Boston, write: “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,” they continue.
“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,” the authors conclude.
JAMA Intern Med. Published online February 24, 2014. doi:10.1001/jamainternmed.2013.13746