BP Meds Increase Fall Risk

AJMC reported  a recent study finds that older patients who are starting medication to manage their blood pressure may be at an increased risk for traumatic falls. Among more than 60,000 nursing home residents who take anti hypertensive medication that particularly experience dementia and high blood pressure have experienced up to 5 excess fractures due to falls per 100 persons-years.

“The findings of this study have important clinical implications. Despite ongoing efforts, the incidence of fall-related mortality has continued to trend upward in the United States, nearly doubling from 2000 to 2013, from 29.6 to 56.7 deaths per 100,000 adults. Falls are also the primary contributor to fractures, which are associated with worsening global health and a pronounced increase in overall mortality. Notably, among older nursing home residents, hip fractures alone have been linked to 1-year mortality rates exceeding 40%.”

Findings from the study from JAMA Internal Medicine say that patients who started taking antihypertensive medications have a higher risk of falls and fractures within 30 days after start date, despite preventive measures already taken by nursing homes.

In the primary analysis, the excess rate of fractures for the 12,942 patients taking antihypertensive medication was 3.1 per 100 person-years compared to the 51,768 residents from the same nursing home. The secondary analysis of patient data showed that the initiation of antihypertensive medication, also was related to the increase of falls that result in hospitalization or emergency department visits. The subgroup analyses of the patients showed that there are varying levels of elevated risk for dementia, elevated systolic and diastolic blood pressures, with no prior use of antihypertensives.

“Patients with dementia have a higher risk of falls and fractures due to a variety of factors, including impaired cognition, gait abnormalities, and use of other medications that are associated with fall risk (eg, benzodiazepines),” “This risk could be further exacerbated in this subgroup during antihypertensive medication initiation due to poorer reporting of subjective symptoms associated with orthostasis and falls (eg, dizziness).”

A pair of researchers reflected on the study’s findings and have suggested many recommendations for older patients who are starting hypertensive medications, while also  emphasizing the importance of personalized approaches for treating the diverse group of patients.

The guidelines say:

■ Start with the lowest dose available when initiating treatment
■ Monitor orthostatic vitals the week of initiation or when there is a change in dose
■ Avoid rapid intensification of treatment and allow at least a month for acclimating to a new drug or dose in alignment with the SPRINT protocol