March 5, 2014
A Balancing Act: BP Medications and Patient Falls

New Haven, CT—Deciding how aggressively older patients should be medicated for hypertension can be a balancing act in more ways than one.

A new study lead by researchers from the Yale School of Medicine found that medication to treat high blood pressure (BP) in older patients showed an association with increased risk for serious injury from falling. The risk was heightened in patients who had previously sustained fall injuries, such as hip fractures, according to the report published recently in JAMA Internal Medicine.

For the study, researchers looked at serious injuries from falls in 4,961 patients older than 70 who had been diagnosed with hypertension. In the study group, 14.1% took no BP medications, 54.6% had moderate exposure to the drugs, and 31.3% took high doses.

“During a three-year follow-up, 446 patients (9%) experienced serious injuries from falls,” the authors write. “The risk for serious injuries from falls was higher for patients who used antihypertensive medication than for nonusers and even higher for patients who had had a previous fall injury.”

Background in the article points out that falls account for 10% of emergency department visits and 6% of hospitalizations among those over age 65.

Lead author Mary E. Tinetti, MD, noted that a single study cannot resolve the dilemma of antihypertensive medications and patient falls or exclude the possibility that factors other than those specific drugs were in play. The research suggests, however, that “these medications may be more harmful in some individuals than thought,” she said.

“Older patients and their clinicians need to weigh the harms as well as the benefits in prescribing medications, particularly when the harms may be at least as serious as the diseases and events we hope the medications prevent,” Tinetti recommended. “Patients may find themselves in the tough position of either choosing to continue their blood pressure medication and risk side effects that could lead to life-altering falls, or discontinuing their medications and risk heart attacks and stroke.”

In a related commentary, Sarah D. Berry, MD, MPH, and Douglas P. Kiel, MD, MPH, of Hebrew SeniorLife, Boston, write, “These findings add evidence that antihypertensive medications are associated with an elevated risk of injurious falls.”

“So how do clinicians reconcile the potential harms and benefits of antihypertensive medications in elderly patients?” the commentators question. “In the absence of direct data, they should individualize the decision to treat hypertension according to functional status, life expectancy and preferences of care. … Most important, clinicians should pay greater attention to fall risk in older adults with hypertension in an effort to prevent injurious falls, particularly among adults with a previous injury.”

U.S. Pharmacist Social Connect