Antihypertensive drugs increased fracture risk in the elderly
A study by US researchers has found that starting antihypertensive medications is associated with an increased risk of fractures and falls in older adults in nursing homes. However, as reported in the JAMA Internal Medicine article, these risks were significantly higher among patients with dementia and higher baseline blood pressure readings.
Injuries are considered the fifth leading cause of death in the elderly, and falls account for two-thirds of these injuries. More than a quarter of falls result in serious injury, and 10 to 15 percent result in fractures, hospitalization or death. That said, some medications are known to be a modifiable risk factor for falls. For example, blood pressure-lowering drugs can exacerbate orthostatic hypotension, in which sudden upright posture causes a drop in blood pressure - a major cause of many falls and, consequently, fractures. However, there is currently little evidence to support an association between the initiation of antihypertensive therapy and fracture risk in elderly patients.
Therefore, researchers from several academic centers, led by Chintan Dave of Rutgers University, conducted a retrospective cohort study of the association between antihypertensive therapy and the risk of fractures and falls in nursing home residents. A total of 12942 antihypertensive therapy initiation cases and 51768 control participants were included in the study.
The incidence of fracture (per 100 person-years) in the group taking antihypertensive medication was 5.4 compared with 2.2 in the control group. This result was consistent with an adjusted hazard ratio of 2.42. Antihypertensive medication use was associated with an increased risk of severe falls requiring emergency department visits or hospitalization (hazard ratio 1.80) and the occurrence of syncope (hazard ratio 1.69).
Among patients with dementia, antihypertensive use was associated with a higher risk of fractures (hazard ratio 3.28). This risk was also increased among patients with a systolic blood pressure of 140 millimeters of mercury column or higher.
According to the researchers, these results suggest that taking antihypertensive medications in the elderly should be considered a significant modifiable risk factor for fractures and falls. However, because of the strong contribution of confounding factors, more research is needed.