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17-05-2016 | Hypertension | News | Article

Antihypertensive initiation, intensification linked to raised short-term fall risk

medwireNews: Older patients initiating or intensifying antihypertensive medication have a short-term increased risk of sustaining a serious fall injury, US study findings indicate.

Although the risk of falls was around a third higher in the first 15 days after treatment initiation compared with longer initiation periods, the absolute risk was low (0.29%) and the researchers did not observe any long-term associations.

Even so, “[t]he short-term risk of serious fall injuries, as well as approaches for reducing this risk should be discussed with older patients when initiating or intensifying antihypertensive medication”, Daichi Shimbo (Columbia University Medical Center, New York) and co-authors remark.

The case-crossover study included 90,127 Medicare beneficiaries who were aged 65 years or older and had a serious fall injury between July 2007 and December 2012.

Among these patients, 272 initiated antihypertensive medication during the 15 days before the fall, 1508 added a new class of antihypertensive medication and 3113 titrated therapy.

Compared with six earlier 15-day periods, the likelihood of a serious fall injury increased 1.36-fold during the first 15 days after antihypertensive medication initiation. The likelihood was also 1.16-fold higher during the 15 days after a new drug class was added and 1.13-fold higher after dose titration, with all these associations being statistically significant.

The researchers note that these associations did not vary by subgroups such as age, gender, race/ethnicity, region, month of fall and medical history. Nor by the class of antihypertensive medication initiated.

When the team analysed the long-term risks, they found no association between initiating or intensifying antihypertensive medication in the 30 to 44 days, 60 to 74 days, or 90 to 104 days before a fall, and the risk of a subsequent fall injury. 

A separate cohort study showed that 0.29% of 65,210 patients initiating antihypertensive medication had a serious fall within 15 days, as did 0.27% of 23,315 adding a new class of antihypertensive medication and 0.29% of 30,143 titrating their medication.

Although this absolute risk for serious fall injuries is low, Shimbo et al point out that the figure for any type of fall “is likely to be substantially higher, as serious fall injuries represent only 10% of all falls experienced by older adults.”

And while serious fall injuries, such as fractures, brain injuries and dislocations have the worst consequences, “falls that do not result in a serious injury are also clinically important as they are associated with functional decline and nursing home placement in older adults”, the team concludes in Circulation: Cardiovascular and Quality Outcomes.

By Laura Cowen

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