Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis

Kahlaee, Hamid Reza; Latt, Mark; Schneider, Carl R.

doi:10.1093/ajh/hpx189

Cited by 40 publications

(29 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although diuretics and its recent dose change were more in fallers, they were not significant predictors of falls. Previous data had some controversies, even though diuretic use might be related to the urgency to get up and move quickly, which could expose them to risky behavior . These factors could be masked by adjustment for environomental hazzards, which depends not only on physical factors but also on human actions .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The relation between falls and medication use among elderly in assisted living facilities

Hamza

Adly

Abdelrahman

et al. 2019

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

Purpose: Many elderly are concerned about falling transfer to assisted living facilities (ALF). Previous literatures studied the medication use and falls in the community, hospitals, or nursing homes, with scanty data about ALF. Therefore, the aim of the current case-control study was to assess the relation between medication use and falls among elderly in ALF. Methods:A matched case-control study was conducted. The study was conducted in ALF in Cairo, Egypt. The study participants were 188 individuals; they were subdivided into two groups: fallers and nonfallers; timed up and go test (TUGT) was performed by all subjects. Medication data were collected according to the fall riskincreasing drugs list and the list of drugs that cause or worsen orthostatism. Other fall risk factors, as suggested by American Geriatric Society, were assessed.Results: The use of vasodilators, diuretics, alpha blockers, opioids, antipsychotics, and sedative hypnotics were more common in fallers than in nonfallers (P < 0.001, P = 0.03, P < 0.001, P = 0.013, P < 0.001, and P < 0.001, respectively). Vasodilators, alpha blockers, and antipsychotics were significant predictors of falls even after adjustment for the possible confounding factors. Vasodilators, alpha blockers, opioids, sedative hypnotics, and recent dose changes in oral hypoglycemics were significant predictors of higher TUGT after adjustment for the possible confounding factors. Conclusion:The current study supported the risk of psychotropic and cardiovascular medications, with especial emphasis on vasodilators, alpha blockers, and antipsychotics, with raising concern about opioids, sedative hypnotics, and recent dose change in oral hypoglycemics.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Some controversies exist between recent systematic reviews, regarding impact of antihypertensives on falls in older adults …”

Section: Introductionmentioning

confidence: 99%

The relation between falls and medication use among elderly in assisted living facilities

Hamza

Adly

Abdelrahman

et al. 2019

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…16,17 Furthermore, several studies have shown that the chronic treatment of hypertension with certain medications, especially calcium channel blockers and angiotensin converting enzyme inhibitors (ACEi), is associated with a reduction in OH or falls. 18–20…”

mentioning

confidence: 99%

Hypertension Treatment Effects on Orthostatic Hypotension and Its Relationship With Cardiovascular Disease

et al. 2018

View full text Add to dashboard Cite

While orthostatic hypotension (OH) is often considered a contraindication to blood pressure (BP) treatment, evidence is lacking. We examined the effect of BP goal or initial medication choice on OH in AASK (African American Study of Kidney Disease), a 2×3 factorial trial. African Americans with chronic kidney disease (CKD) attributed to hypertension were randomly assigned one of two BP goals: intensive (mean arterial pressure [MAP]≤92mmHg) or standard (MAP 102–107mmHg), and one of three initial medications (ramipril, metoprolol, amlodipine). Postural changes in systolic BP (SBP), diastolic BP (DBP), or heart rate (HR) were determined after 2:45minutes of standing. OH was assessed each visit and defined using the consensus definition (drop in SBP≥20mmHg or DBP≥10mmHg). Median follow-up was 4-years. Outcomes were congestive heart failure, stroke, nonfatal cardiovascular disease (CVD), fatal CVD, any CVD (composite of preceding events), and all-cause mortality. There were 1,094 participants (mean age 54.5±10.7yrs; 38.8% female; OH was assessed at 52,864 visits). Mean seated SBP, DBP, and HR were 150.3±23.9mmHg, 95.5±14.2mmHg, and 72.0±12.6bpm. A more intensive BP goal did not alter the distributions of standing BP and was not associated with OH, but metoprolol was associated with systolic OH compared to ramipril (OR 1.68; 95%CI:1.15,2.46) and amlodipine (OR 1.94;95%CI:1.09,3.44). While consensus OH was associated with stroke (HR 5.01;95%CI:1.80,13.92), nonfatal CVD (HR 2.28;95%CI:1.21,4.30), and any CVD event (HR 2.12;95%CI:1.12,3.98), neither BP goal or medication altered this risk. Concerns about causing OH or its CVD consequences should not deter a lower BP goal among adults with CKD attributed to hypertension.

show abstract

“…Several studies have concluded that chronic usage of antihypertensives is not associated with an increased risk of falls [57,58], and two meta-analyses found that chronic usage of antihypertensive drugs did not significantly increase the risk of falls or fall injuries [59,60]. Data analysis from the REGARDS study concluded that the number of antihypertensive medication classes used was not associated with an increased fall risk [61].…”

Section: Antihypertensive Usagementioning

confidence: 99%

“…Intensive treatment of blood pressure (with a systolic blood pressure target under 120 mmHg) was associated with an increased risk of hypotension, but not falls [62]. Some studies have found an association between antihypertensives and severe fall injuries (especially those with previous fall injuries) [63], associations between loop diuretics and falls [58,64], and associations within the setting of first time or acute usage of antihypertensive agents [57,59,65,66]. Even with careful administration and usage of lowest effective doses, hypotensive medications may precipitate a fall or syncope in the early stages of usage [57,59,66].…”

Section: Antihypertensive Usagementioning

confidence: 99%

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

Mikoś

Winnicki

Henry

et al. 2021

Polish Archives of Internal Medicine

View full text Add to dashboard Cite

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

show abstract

Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis

Abstract: There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.

Cited by 40 publications

References 52 publications

The relation between falls and medication use among elderly in assisted living facilities

The relation between falls and medication use among elderly in assisted living facilities

Hypertension Treatment Effects on Orthostatic Hypotension and Its Relationship With Cardiovascular Disease

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

Contact Info

Product

Resources

About