January 18, 2019
By David Douglas
NEW YORK (Reuters Health) - Long-term treatment and control of high blood pressure does not increase the risk of falls in postmenopausal women, according to a prospective cohort study.
This finding "goes against what many doctors intuitively think: that treatment for high blood pressure may increase the risk of falls," said Dr. Karen L. Margolis of HealthPartners Institute in Minneapolis
"Therefore, they worry that the protection against strokes and heart disease conferred by treatment of high blood pressure may be offset by harms related to injuries from falls. For the most part, I don't think this worry appears to be justified," she told Reuters Health by email.
For their study, online January 7 in the Journal of the American Geriatric Society, Dr. Margolis and colleagues examined data on almost 6,000 community-living women with a mean age of 79 years taking part in a long-term study.
At baseline, 70% of the women had hypertension. This was treated and controlled in 53%, treated but uncontrolled in 12% and untreated in 5%. Among antihypertensive drugs employed were thiazide diuretics, beta-blockers and angiotensin-converting-enzyme (ACE) inhibitors.
In the first year of surveillance, 2,582 women (43%) reported falls. After adjustment, compared to women without hypertension, the incidence ratio (IRR) for falls was 0.82 (P=0.0008) in women with treated and controlled hypertension and 0.73 (P=0.0004) in those with treated but uncontrolled hypertension.
Overall, neither systolic nor diastolic BP was associated with risk of falls. However, in a model adjusted for fall risk factors, higher diastolic BP was associated with a lower risk of falls. This amounted to an IRR of 0.993 per mm Hg.
Compared with other types of antihypertensive medication, beta-blockers were the only class associated with falls. However, the association was attenuated when adjusting for fall risk factors and lost significance after adjusting for lower limb physical function.
Despite the apparent absence of long-term risks, Dr. Margolis pointed out that "there is consistent data from very large database studies in the UK, Canada, and U.S. that there is a slightly increased risk of falls that result in serious injury in the first few weeks after hypertension medication is added or adjusted."
Thus "patients should be monitored during this period to make sure they're doing well with the medication change - a common sense suggestion for just about any medication adjustment. I believe that the long-term benefits of blood pressure control exceed the small risks of falls and related injuries that may occur in the first few weeks after treatment is initiated or adjusted."
Dr. Ken Madden, chair of geriatric medicine at the University of British Columbia, in Vancouver, Canada, told Reuters Health by email, "This paper shows that treating high blood pressure in older adults can be quite complicated, and needs to be individualized for each patient."
"The fact that blood pressure medications might cause lightheadedness in the short term does not necessarily mean they increase the risk of falls due to fainting over the long term, once patients have had time to adjust to their new medications," said Dr. Madden, who was not involved in the study.
J Am Geriatr Soc 2019.
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