February 26, 2014
Rise In Fall Injuries Tied To Medication Used To Control Hypertension
April Flowers for redOrbit.com - Your Universe Online
A new study, published in the journal JAMA Internal Medicine, reveals that medications used by many older people to control their blood pressure also increase the risk of serious fall injuries by 30 to 40 percent. According to the Yale School of Medicine research team, these injuries have a similar effect on mortality and functional loss as the strokes and heart attacks the blood pressure drugs are meant to prevent.
It has long been assumed by doctors that blood pressure medications were safe and effective in all older adults. For healthy older adults, this is probably true. For the typical population of older adults, who commonly have several other chronic conditions, the researchers say those same medications could become problematic.
The majority of people over 70 years of age have high blood pressure. Controlling this condition is key to reducing the risk for myocardial infarction (heart attack) and stroke. Prior studies have suggested that blood pressure may increase the risk of falls and injuries from those falls.
The research team recruited 4,961 patients over the age of 70 who suffered from hypertension to examine the link between BP medication use and serious injuries such as hip fractures and head injuries sustained during falls. The patients fell into three groups: 14 percent took no blood pressure medications, 55 percent took moderate blood pressure medications, and 31 percent took a high dose.
The team performed a follow-up after three years, finding that the risk for serious injuries from falls was higher for patients who used blood pressure medication than for non-users. The risks were even higher for patients who had experienced a previous fall injury.
"Although no single study can settle the question and we cannot exclude the possibility that factors other than the medications accounted for the increased risk of injury, these medications may be more harmful in some individuals than thought," said Mary E. Tinetti, MD, the Gladys Philips Crofoot Professor of Medicine and Public Health and chief of the Section of Geriatrics at Yale School of Medicine.
Sarah D. Berry, MD, MPH, and Douglas P. Kiel, MD, MPH, of Hebrew Senior Life, Boston, commented on the study, "These findings add evidence that antihypertensive medications are associated with an elevated risk of injurious falls."
"An alternative possibility is that the increased risk of injurious falls is due not to antihypertensive medications but rather to the underlying hypertension or overall burden of illness," they continue.
"So how do clinicians reconcile the potential harms and benefits of antihypertensive medications in elderly patients? 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," the authors conclude.