Hypertension Therapy Ups Fall Risk in Older Adults

Mark L. Fuerst

There may be a difficult tradeoff between treating patients with hypertension and preventing serious fall injuries.

Antihypertensive medications may dramatically increase the risk of serious fall injuries among older adults, suggesting there may be a difficult trade-off between treating patients with hypertension and preventing serious fall injuries, including hip fractures.

“It is not uncommon for older adults to say that they think their blood pressure medications are making them feel dizzy, weak, or unsteady. These medications could increase the risk of falling and serious fall injuries for several reasons, including dropping the blood pressure too much, particularly with standing, fatigue, confusion, and decreased alertness. These common adverse effects of antihypertensive medications are known risk factors for falling,” lead author Mary Tinetti, MD, Professor of Medicine and Public Health and Chief of the Section of Geriatrics at Yale School of Medicine, New Haven, Connecticut, told ConsultantLive.

Dr Tinetti led a study of nearly 5000 patients older than 70 years who had hypertension. Among the patients, 14% took no blood pressure medications, 55% took moderate-dose blood pressure medications, and 31% were taking a high dose.

During a 3-year follow-up of these patients, the risk of serious injuries resulting from falls was higher for patients who used blood pressure medication than for nonusers and even higher for patients who had experienced a previous fall injury.

“We cannot say for sure that antihypertensive medications led to the serious fall injuries, such as hip fractures,” Dr Tinetti said. “Although no single study is definitive, results suggest that findings in randomized clinical trials of healthy older adults may not reflect what happens to more typical older adults.”

“The mortality and loss of function associated with serious fall-related injuries, such as hip fractures, and serious head injuries are comparable to that associated with cardiovascular events, such as strokes and myocardial infarctions, the events we are trying to prevent with blood pressure medications,” Dr Tinetti noted.

The potential harms versus benefits of antihypertensive medications should be weighed in deciding how aggressively to treat hypertension in older adults who have multiple chronic conditions, Dr Tinetti suggested.

“Some older adults are at greater risk for having a stroke, and controlling their blood pressure is in their best interest. This may be particularly true for healthier older adults who are not at high risk for falling,” she said.

“However, for others, the risk of a serious fall injury, such as head injury or hip fracture, may outweigh the benefit of blood pressure medications. This may be particularly true of older adults with a history of falling, with multiple conditions, with difficulty with mobility, or with functional disabilities.”

Doctors also need to ask patients about their own priorities and preferences, Dr Tinetti stated. “In a study we did a few years ago, we asked older adults with high blood pressure whether they were more concerned about having a stroke or heart attack versus suffering a fracture, serious injury, or adverse effects of blood pressure medications,” she said. “We found that people are about equally divided between these two possibilities. Therefore, it is important to consider people’s priorities and preferences in making the decision.”

Dr Tinetti suggests that primary care physicians consider whether it is safer to continue blood pressure medications or to taper them in every older adult who has multiple chronic conditions and always check postural blood pressures and consider effective ways to prevent fall injuries.

The researchers published their results in the February 24, 2014, issue of JAMA Internal Medicine.