Blood pressure meds may raise elderly fall risk

(Reuters Health) – Older people who take blood pressure medications had more serious injuries from falls than those not taking medications, according to a new study.

The added risk with blood pressure meds for falls that cause serious injury has been suggested before, but older people shouldn’t stop taking their medications based just on these results, the authors say.

“It is important to remember that no single study, and particularly an observational study such as ours, can give a definitive answer,” said Dr. Mary E. Tinetti, who led the research.

“We cannot say definitively that antihypertensive medications led to serious fall injuries such as hip fractures,” said Tinetti, a geriatrics researcher at Yale School of Medicine in New Haven, Connecticut.

Most people over 70 years of age have high blood pressure, or hypertension, which increases the risk for heart attacks and stroke. Currently, antihypertensive medications including diuretics like Tenoretic, beta blockers like Lopressor and ACE inhibitors, often taken together, are the best way of managing the health risks of high blood pressure.

Among U.S. adults with high blood pressure in 2012, 83 percent were aware of their condition and 76 percent were taking medications to treat it, according to a Centers for Disease Control and Prevention Survey.

For the new study, the researchers used existing, publicly available data on hospitalizations after a serious fall for almost 5,000 patients over 70 with hypertension.

Based on the patients’ dosing of high blood pressure drugs and the number of different drugs they were taking over the three-year study period, researchers divided them into three groups of medication “intensity.”

The patients’ average age was 80 and 14 percent were taking no high blood pressure medications at all, while 55 percent were on a moderate-intensity regimen of blood pressure medications and 31 percent were on a high-intensity drug regimen.

Among those taking medication, more than a third were on at least three different kinds of blood pressure drugs.

Over the three years of the study, 446 patients suffered a serious injury, like hip fracture or head injury.

Compared to the no-medication group, those in the moderate-intensity medication group were 1.4 times as likely to suffer a serious injury from a fall, and those in the high intensity group were 1.3 times as likely.

Overall, however, the increased risk was still small, according to results in JAMA Internal Medicine.

Of the 4,961 people included in the study, 52 (7.5 percent) in the no-medication group had a serious fall injury, compared to 267 (9.8 percent) in the moderate-intensity medication group and 127 (8.2 percent) in the high-intensity group.

“Clinically, it is not uncommon for an older adult to say that they think their blood pressure medications are making them feel dizzy or weak or unsteady,” Tinetti told Reuters Health in an email.

The way this study was designed, it is difficult to identify other factors that could be influencing fall risk.

It is possible, Tinetti said, that people who were at greater risk of fall injury to begin with were also at greater risk of being prescribed blood pressure medications, though even in a smaller group with similar medication users and non-users compared, the results remained the same.

“Interestingly the authors did not find that any one class of medications was safer with respect to the risk of injurious falls, so much is unknown about the mechanism leading to injury,” said Dr. Sarah D. Berry of the Institute for Aging Research at the Hebrew Rehabilitation Center in Boston.

Berry authored a commentary published alongside the new study.

Diuretics directly affect bone mineral density and could lead to an increased risk of fracture, Berry said.

Other medications might cause dizziness or lightheadedness that accompanies drops in blood pressure and could lead to falls that way, she added.

Determining which factor is more important, the risk of heart disease and stroke or fall injuries, will depend on the individual patient, Tinetti said – there appears to be a tradeoff between the two.

“It is probably the case that some older adults are at greater risk of having a stroke and controlling their blood pressure is in their best interest,” 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.”

Patients and their doctors should make treatment decisions on an individual basis, and doctors should remember to ask their patients what their priorities are as well, she said.

SOURCE: bit.ly/NvtVOg JAMA Internal Medicine, online February 24, 2014.