Antihypertensive drugs may raise fall risk in elderly

By Kathryn Doyle

 Antihypertensive medications were associated with an increased risk of serious fall injuries, particularly among those with previous fall injuries, in a study of elderly people.

The added risk with antihypertensive medications for falls that cause serious injury has been suggested before, but older people shouldn't stop taking their medications based just on these results, the authors say.

"It is important to remember that no single study, and particularly an observational study such as ours, can give a definitive answer," said Dr. Mary E. Tinetti, who led the research.

"We cannot say definitively that antihypertensive medications led to serious fall injuries such as hip fractures," said Tinetti, a geriatrics researcher at Yale School of Medicine in New Haven, Connecticut.

The researchers used existing, publicly available data on hospitalizations after a serious fall for almost 5,000 patients over age 70 with hypertension.

Based on the patients' dosing of antihypertensive drugs and the number of different drugs they were taking over the three-year study period, the researchers divided them into three groups of medication "intensity."

The patients' average age was 80 and 14% were taking no antihypertensive medications, while 55% were on a moderate-intensity antihypertensive regimen and 31% were on a high-intensity drug regimen.

Among those taking medication, more than a third were on at least three different kinds of blood pressure drugs.

Over the three years of the study, 446 patients suffered a serious injury, like hip fracture or head injury.

Compared to the no-medication group, those in the moderate-intensity medication group were 1.4 times as likely to suffer a serious injury from a fall, and those in the high intensity group were 1.3 times as likely.

Overall, however, the increased risk was still small, the researchers note in JAMA Internal Medicine February 24.

Of the 4,961 people included in the study, 52 (7.5%) in the no-medication group had a serious fall injury, compared to 267 (9.8%) in the moderate-intensity medication group and 127 (8.2%) in the high-intensity group.

"Clinically, it is not uncommon for an older adult to say that they think their blood pressure medications are making them feel dizzy or weak or unsteady," Tinetti told Reuters Health in an email.

The way this study was designed, it is difficult to identify other factors that could be influencing fall risk.

It is possible, Tinetti said, that people who were at greater risk of fall injury to begin with were also at greater risk of being prescribed blood pressure medications, though even in a smaller group with similar medication users and non-users compared, the results remained the same.

"Interestingly the authors did not find that any one class of medications was safer with respect to the risk of injurious falls, so much is unknown about the mechanism leading to injury," said Dr. Sarah D. Berry of the Institute for Aging Research at the Hebrew Rehabilitation Center in Boston, who authored a commentary published with the study.

Diuretics directly affect bone mineral density and could lead to an increased risk of fracture, Berry said. Other medications might cause dizziness or lightheadedness that accompanies drops in blood pressure and could lead to falls that way, she said.

"The effect of serious injuries, such as hip fracture and head injury, on mortality and function is comparable to that of cardiovascular events," the authors note in their paper.

"The potential harms vs benefits of antihypertensive medications should be weighed in deciding to continue treatment with antihypertensive medications in older adults with multiple chronic conditions," they conclude.

Berry agrees. "It is probably the case that some older adults are at greater risk of having a stroke and controlling their blood pressure is in their best interest," she said. "However, for others, the risk of a serious fall injury such as head injury or hip fracture may outweigh the benefit of blood pressure medications."

Patients and their doctors should make treatment decisions on an individual basis, and doctors should remember to ask their patients what their priorities are as well, she said.

SOURCE: http://bit.ly/NvtVOg

JAMA Intern Med 2014.

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