Antihypertensives Linked to Serious Fall Risk in Elderly Patients

Elderly patients who take antihypertensive medications appear to have an elevated risk of serious falls, especially if they have previously been injured in a fall, but experts caution that the risk-benefit calculus of taking antihypertensives must be considered on an individual basis.

Older adults taking antihypertensive medications may be more likely to sustain serious injuries from falls than are those not taking antihypertensives, according to the results of a study published online on February 24, 2014, in JAMA Internal Medicine.

Based on concerns that antihypertensive medications may be associated with serious falls among older adults, the researchers looked for evidence of this association in a nationally representative sample of adults aged 70 years and older. Hypertension patients enrolled from 2004 through 2007 in the Medicare Current Beneficiary Survey were interviewed to determine their antihypertensive medication exposure intensity, which was calculated based on the average total daily dose of antihypertensive medication. The researchers also looked at the number of different antihypertensive medication classes each patient took. The researchers followed patients for up to 3 years through 2009, using claim records to track serious fall injuries including hip and other major fractures, traumatic brain injuries, and joint dislocations.

Of 4961 patients included in the study, 446 (9%) experienced serious fall injuries, and 837 (16.9%) died during follow up. The results from a multivariate analysis accounting for additional factors indicated an association between use of antihypertensive medications and increased risk of serious fall injuries. Compared with patients who did not use antihypertensive medications, patients considered to be moderate- and high-intensity users of the medications had hazard ratios for serious fall injuries of 1.40 and 1.28, respectively.

Although the differences in hazard ratios across the groups were not statistically significant, the association was stronger among patients who had experienced a previous fall injury. Among the 503 participants who had previously sustained an injury after a fall, the hazard ratios reached 2.17 among moderate-intensity and 2.31 among high-intensity users of antihypertensive medications. When analyzed by class of antihypertensive, no class was associated with an increased risk of fall injuries.

There are several possible explanations for why antihypertensive medications may increase the risk for serious falls, the authors of an accompanying editorial note. The increased risk may be caused by possible effects of specific drug classes on fracture risk, by possible effects of the drugs on blood pressure and orthostasis, or by the effects of the underlying hypertension itself.

The editorialists warn that the association between antihypertensive medications and serious falls remains uncertain, and undertreating hypertension can be dangerous. Therefore, they suggest that health care providers weigh the risks and benefits of hypertensive medications individually for older patients with multiple chronic conditions.

“For some patients, concern about injurious falls may be paramount, whereas other patients fear the complications of untreated hypertension,” they write. “Unfortunately, there is no easy way for clinicians to compare these risks; thus, a candid discussion with each patient is advisable.”