Blood Pressure Rx May Increase Falls in Elderly

Antihypertensives were associated with more serious falls in older adults

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Controlling high blood pressure with medications can reduce the risk for certain heart conditions, but it can also increase the risk of other events.

Dizziness and problems with balance are among the most common medication side effects, including from medications taken to treat high blood pressure. Since falls are a serious hazard in older adults, a team of researchers was interested in finding out if blood pressure medications increased the risk of falls.

These researchers found an association between high blood pressure medications and an increased risk of serious fall injury in adults over 70.

"Tell your doctor if you are prone to falls."

Mary E. Tinetti, MD, from the Yale School of Medicine and Yale School of Public Health in New Haven, CT, was the lead author of this research.

Information on study participants was collected from a Medicare survey of the enrolled subjects from 2004 to 2007.

These patients took many different blood pressure medications, so the researchers grouped the medications by doses taken and split the patients into three groups:

  • No blood pressure medications taken
  • Medium/moderate-dose blood pressure medication
  • High-dose blood pressure medication

A total of 14 percent of the patients were taking no blood pressure medication, 55 percent were taking medium/moderate-dose blood pressure medication and 31 percent were taking high-dose blood pressure medication.

Emergency department and hospitalization records were reviewed to collect data on injuries related to falls. The research team defined a serious fall injury as one that resulted in broken bone(s), brain injury or dislocated joints.

Dr. Tinetti and her team found that 9 percent of the patients had a serious fall injury. There were several different types of serious injuries, including 107 broken hips, 345 other major fractures, 72 major head injuries and 16 major joint dislocations.

Serious fall injuries occurred in each study group. However, the subjects taking a moderate dose of a blood pressure medication had a 40 percent increased risk for serious fall injury compared to those not taking blood pressure medications. Patients taking high doses were 28 percent more likely to have a serious fall injury compared to those not taking blood pressure medication.

When the researchers looked just at the patients who had a previous fall injury, they found that those taking blood pressure medication were twice as likely to experience another serious fall injury as those not taking blood pressure medication.

A total of 25 percent of the patients who experienced a serious fall injury died during the follow-up period, compared with 16 percent of the patients who did not have a serious fall injury.

One limitation of this study was that, since blood pressure was not measured, the researchers could not determine if a change in blood pressure caused the falls.

“It is important, therefore, to consider the effects of medications not only on the conditions for which the medications are indicated but also on coexisting conditions, including fall injury risk,” the authors recommended.

They further suggested, “Treatment decisions should be predicated on maximizing benefit and minimizing harm, preferably based on risk stratification.”

This research was published in the February issue of JAMA.

A grant from the National Institute on Aging provided funding for this study.

Study co-author Cary P. Gross, MD, disclosed receiving research funding from Medtronic and 21st Centure Oncology and being on the Scientific Advisory Board of Fair Health, Inc. No other conflicts of interest were reported.

Review Date: 
February 22, 2014
Last Updated:
February 24, 2014