Antihypertensive Medication and Risk of Falls in Older Adults
In older adults, what are associations between antihypertensive medication initiation and intensification and short- and long-term risk of falls?
The authors conducted two types of analyses using a national 5% random sample of Medicare beneficiaries from 2006 to 2012. The first analysis was a retrospective cohort study, which was used to estimate the absolute risk for serious fall injuries among Medicare beneficiaries initiating and adding a new antihypertensive medication class or titrating antihypertensive medication. The second analysis was a case-crossover study of Medicare beneficiaries who experienced a serious fall injury to determine whether initiating and adding a new class or titrating antihypertensive medication were associated with an increased risk for serious fall injuries. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods).
A total of 65,210 Medicare beneficiaries who met the inclusion criteria initiated antihypertensive medication. Of this population, 186 (0.29%) Medicare beneficiaries had a serious fall injury within 15 days after treatment initiation. The short-term odds ratios for a serious fall injury were 1.36 (95% confidence interval [CI], 1.19-1.55) for initiation of antihypertensive medication, 1.16 (95% CI, 1.10-1.23) for adding a new antihypertensive medication class, and 1.13 (95% CI, 1.08-1.18) for antihypertensive medication titration. These associations were attenuated beyond 15 days.
Among older adults, the odds for a serious fall injury were increased in the 15 days after antihypertensive medication initiation and intensification. This increased risk was attenuated after 15 days.
This is a valuable study, which suggests that the short-term risk of a serious fall injury following antihypertensive medication initiation and intensification is low and does not extend to the long term (beyond 15 days). Such results should provide a measure of confidence to clinicians advocating for more aggressive blood pressure targets in select older adults. That said, the authors did not account for all falls (only serious fall injuries). Minor falls, still associated with significant morbidity, are probably more common and may temper enthusiasm for aggressive blood pressure control in select older adults.
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