Individualized Medication Plan

McKnight’s reported on a new disconcerting study about blood pressure medication increasing the risk of falls especially with people suffering from dementia. JAMA Internal Medicine published a study showing residents in nursing homes who took antihypertensive medicines had higher risks for falls and fractures.

Authors of the report said the risks for falling or getting fractures were even higher among those with dementia, those with higher blood pressure in general, and those who didn’t take medications to lower their blood pressure recently.

The incidence rate of fractures per 100 person-years in residents starting antihypertensive medication was 5.4 compared with 2.2 who didn’t start medicines. People in nursing homes who started high blood pressure drugs were 2.42 times more likely to have a fracture and 1.80 times more likely to be hospitalized or go to an emergency room for severe falls compared to those not on the medications.

“Caution and additional monitoring are advised when initiating antihypertensive medication in this vulnerable population,” the authors wrote.

In a related commentary published in the same journal, Muna Thalji Canales, MD, a researcher said medical professionals need to be cautious when starting or increasing antihypertensive therapy in the older adult nursing home population. Begin with the lowest dose possible when starting a new medication.

“Some of these measures would require adequate staffing and added health care practitioner involvement, an ideal that may not be realistic,” she wrote.

“Ultimately, the question of how to treat blood pressure in older nursing home residents remains one that must be individualized,” Thalji Canales added.