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Serious fall injuries increased in older adults on antihypertensive agents
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Antihypertensive medications were associated with an increased risk for serious fall injuries in adults aged older than 70 years in a new study.
The link was strongest in those with previous injuries from falls, researchers found.
“The effect of serious injuries, such as hip fracture and head injury, on mortality and function is comparable to that of cardiovascular events. Concerns have been raised about the risk of fall injuries in older adults taking antihypertensive medications,” Mary E. Tinetti, MD, of Yale School of Medicine, and colleagues wrote. “The low risk of fall injuries reported in clinical trials of healthy older adults may not reflect the risk in older adults with multiple chronic conditions.”
The researchers conducted a study of 4,961 community-living participants aged older than 70 years with hypertension to determine whether antihypertensive medication use was linked to risk for a serious fall injury. Participants were followed for up to 3 years.
The primary outcome was serious fall injuries, including hip and other major fractures, traumatic brain injuries and joint dislocations. Participants were stratified by antihypertensive medication intensity based on the standardized daily dose for each medication class.
Overall, 54.6% of participants received moderate-intensity antihypertensive medications, 31.3% received high-intensity antihypertensive medications and 14.1% received no antihypertensive medications.
During follow-up, 9% of participants experienced serious injuries related to falls and 16.9% died. Of those who had a serious fall, 24.9% died; of those who did not, 16.1% died.
More falls for participants on therapy
Compared with participants who did not receive antihypertensive medications, the adjusted HRs for serious fall injury were 1.4 (95% CI, 1.03-1.9) in the moderate-intensity antihypertensive medication group and 1.28 (95% CI, 0.91-1.8) in the high-intensity antihypertensive medication group.
Although the difference in adjusted HRs across the groups did not reach statistical significance, results were similar in a propensity score-matched subcohort of 2,849 participants (moderate-intensity antihypertensive medication, HR=1.22; 95% CI, 0.8-1.71; high-intensity antihypertensive medication, HR=1.24; 95% CI, 0.83-1.84), the researchers wrote.
For the 503 participants with a previous fall injury, the adjusted HRs were 2.17 (95% CI, 0.98-4.8) for the moderate-intensity antihypertensive medication group and 2.31 (95% CI, 1.01-5.29) for the high-intensity antihypertensive medication group vs. those who did not receive antihypertensive medications.
Although this study is observational and cannot establish cause and effect, “the potential harms vs. benefits of antihypertensive medications should be weighed in deciding whether to continue antihypertensives in older adults with multiple chronic conditions,” Tinetti and colleagues wrote.
Individualize treatment
In a related editorial, Sarah D. Berry, MD, MPH, and Douglas P. Kiel, MD, MPH, both from Beth Israel Deaconess Medical Center, Harvard Medical School, said the best approach for doctors is to “individualize the decision to treat hypertension according to functional status, life expectancy and preferences of care,” which requires “a candid discussion with each patient.
“When antihypertensive drug treatment is indicated, using the lowest dose possible to achieve a target [BP] makes good sense,” Berry and Kiel wrote. “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.”
For more information:
Berry SD. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2013.13746.
Tinetti ME. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2013.14764.
Disclosure: One researcher reports financial ties with Fair Health Inc., Medtronic and 21st Century Oncology. The other researchers report no relevant financial disclosures. Berry reports financial ties with UpToDate. Kiel reports financial ties with Amgen, Ammonett Pharma, Eli Lilly, Merck and UpToDate.