Rx to Lower BP Didn't Lead to More Falls, Breaks

More controlled blood pressure was unlikely to cause older patients to fall and break bones

(RxWiki News) As people age, they tend to fall more often and break bones. But, contrary to what previous research suggested, medications to lower blood pressure don’t seem to add to the problem, new research suggests.

People whose blood pressures were significantly lowered with medication did not fall more often or break more bones than those whose blood pressures were less tightly controlled, a new study found.

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The research was conducted by Karen Margolis, MD, of the HealthPartners Institute for Education and Research in Bloomington, MN, and colleagues.

The study authors noted that many practitioners were concerned about prescribing medication to lower blood pressure because they think low blood pressure may lead to more falls and broken bones. Little research has supported this thinking, and the authors wanted to find out if it was true.

The researchers used data from the Action to Control Cardiovascular Risk in Diabetes trial.

All of the participants had Type 2 diabetes (non-insulin-dependent diabetes). All were younger than 80, and the average age was 62.

If those older than 80 were included, the results might have been different because they "tend to be most apt to take a fall," noted Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, TX.

Just over 1,500 patients received medications aimed at reducing their systolic (top number) blood pressure to 120 millimeters of mercury (mm Hg) or less — this was the tightly controlled group.

Another group of over 1,500 patients was not as controlled — they received medicine aimed at reducing their systolic blood pressure to 140 mm Hg or less.

Almost 90 percent of participants took medication to reduce their blood pressure. The patients were followed for up to five years. Every year, they reported on how many falls they had and whether they had experienced any nonspinal bone breaks.

The overall fall rate was 69.8 falls per 100 person-years. In all, 270 people had a confirmed nonspinal break.

Those whose blood pressures were most tightly controlled did not have more falls or broken bones than those whose blood pressures were less tightly monitored, the researchers found.

The authors noted that most physicians do not follow their patients as closely as the patients in this study were followed.

“It is a bit surprising, and runs counter to popular opinion, that intensive blood pressure lowering did not increase the likelihood of falls in elderly diabetic patients," Dr. Samaan told dailyRx News. "These are exactly the people we worry the most about, since they tend to be more frail, and their reflexes may not be as brisk as younger, healthier people. I think it's important to note that all of the patients in the study were monitored closely. Although the intensive therapy group did achieve lower blood pressures, the goal was not extreme, and patients were monitored every four months, so medications could be adjusted up or down as needed.”

Dr. Samaan noted that the blood pressure medication did not seem to prevent cardiac events in these people.

“Overall the intensive lowering did not impact the risk of heart attacks or death from cardiovascular disease, so the potential downsides (including cost and risk of side effects from multiple medications) were generally not worth the risk,” she said.

This study appears in the August issue of the Journal of General Internal Medicine.

The National Institute of Diabetes and Digestive and Kidney Diseases funded the study. The authors disclosed no conflicts of interest.

Review Date: 
August 19, 2014