Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension

Bromfield, Samantha G.; Ngameni, Cedric-Anthony; Colantonio, Lisandro D.; Bowling, C. Barrett; Shimbo, Daichi; Reynolds, Kristi; Safford, Monika M.; Banach, Maciej; Tóth, Peter P.; Muntner, Paul

doi:10.1161/hypertensionaha.116.09390

Cited by 112 publications

(95 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is well known that the diagnosis of hypertension is traditionally defined by the clinic BP [22][23][24]. Prior randomized clinical trials and metaanalysis have consistently demonstrated that reducing clinic BP can improve cardiovascular outcomes [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Association of masked uncontrolled hypertension and cardiovascular diseases in treated hypertensive patients

Shi

Zhang

Wang

et al. 2020

aoms

View full text Add to dashboard Cite

The aim of the study was to evaluate the association of masked uncontrolled hypertension (MUCH) and prevalence of cardiovascular disease in treated hypertensive patients. Material and methods: Patients' demographics and prior medical histories were collected. Fasting venous blood was drawn for evaluation of serum creatinine level, which was used to calculate glomerular filtration rate (GFR). Clinic blood pressure (BP) and 24 h ambulatory blood pressure monitoring (ABPM) measurements were performed. Based on the clinic BP and 24 h ABPM results, patients were divided into MUCH and non-masked hypertension groups. Results: Compared to patients without masked hypertension, MUCH patients were older (62.4 ±11.2 vs. 59.7 ±10.4 years, p < 0.05), more likely to be male (66.9% vs. 63.4%), had diabetes (33.9% vs. 29.6%), longer hypertension duration (12.4 ±5.3 vs. 9.5 ±4.5 years, p < 0.05), lower GFR (79.5 ±11.6 vs. 82.4 ±10.3 ml/min/1.73 m 2 , p < 0.05), treated with b-blocker (39.0% vs. 32.7%, p < 0.05) and required more antihypertensive medications (2.7 ±0.5 vs. 2.2 ±0.3, p < 0.05). MUCH patients have higher cardiovascular disease prevalence than that without masked hypertension (30.1% vs. 23.4%, p < 0.05). After adjustment for covariates, MUCH was still independently associated with higher cardiovascular disease prevalence with odds ratio 1.38 (95% confidence interval 1.17-1.62, p < 0.05). Conclusions: The MUCH is independently associated with prevalent cardiovascular disease in treated hypertensive patients. Future studies are needed to evaluate whether correction of MUCH can improve patients' outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of masked uncontrolled hypertension and cardiovascular diseases in treated hypertensive patients

Shi

Zhang

Wang

et al. 2020

aoms

View full text Add to dashboard Cite

show abstract

“…Given the lack of evidence for an association of long‐term antihypertensive treatment with falls, why do clinicians commonly cite the risk of falls as a reason not to treat to lower BP targets in older individuals? In contrast to the weak inverse association of seated diastolic BP with self‐reported falls in the current study among treated women treated for hypertension, Bromfield et al did not find an association of either seated systolic or diastolic BP with serious fall injuries ascertained via a claims algorithm . Further study is needed on whether low levels of treated diastolic BP are associated with an increased risk of falls and whether a different mechanism links diastolic vs systolic BP with fall propensity.…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, little evidence exists for a causal mechanism or an association of chronic antihypertensive treatment with falls in the literature or in this study, even in the subgroup of women with an increased falls risk due to low measured physical function. However, a growing body of evidence indicates that the risk of falls and fractures is increased in the first several weeks following initiation or intensification of antihypertensive therapy .…”

Section: Discussionmentioning

confidence: 99%

“…5,6,8 Prospective observational studies also did not generally show that individuals on antihypertensive treatment have an increased risk of fractures and other serious injuries. [9][10][11][12][13] In contrast to the findings from long-term clinical trials and observational studies, observational studies using large national databases consistently found a short-term increased risk of injurious falls and hip fracture in the 14-to 45-day period immediately following initiation of antihypertensive or diuretic therapy in older patients. [14][15][16][17][18] In this article we present data on the association of prospectively collected data on falls with hypertension, measured BP, and antihypertensive treatment in a large and diverse population of older women enrolled in the Women's Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health (OPACH) study.…”

mentioning

confidence: 96%

See 1 more Smart Citation

Hypertension Treatment and Control and Risk of Falls in Older Women

Margolis

Buchner

LaMonte

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

BACKGROUND/OBJECTIVES A lower risk of falls is commonly cited as a reason to treat hypertension conservatively in older individuals. We examined the effect of hypertension treatment and control status and measured blood pressure (BP) level on the risk of falls in older women. DESIGN/SETTING Prospective cohort study. PARTICIPANTS A total of 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) enrolled in the Women's Health Initiative and Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS BP was measured by trained nurses, and hypertension treatment was assessed by medication inventory. Participants mailed in monthly calendars to self‐report falls for 1 year. RESULTS Overall, 70% of women had hypertension at baseline (53% treated and controlled, 12% treated and uncontrolled, 5% untreated). There were 2582 women (43%) who reported falls in the 1 year of surveillance. Compared with nonhypertensive women, when adjusted for fall risk factors and lower limb physical function, the incidence rate ratio (IRR) for falls was 0.82 (confidence interval [CI] = 0.74‐0.92) in women with treated controlled hypertension (p = .0008) and 0.73 (CI = 0.62‐0.87) in women with treated uncontrolled hypertension (p = .0004). Neither measured systolic nor diastolic BP was associated with falls in the overall cohort. In women treated with antihypertensive medication, higher diastolic BP was associated with a lower risk of falls in a model adjusted for fall risk factors (IRR = 0.993 per mm Hg; 95% CI = 0.987‐1.000; p = .04). The only class of antihypertensive medication associated with an increased risk of falls compared with all other types of antihypertensive drugs was β‐blockers. CONCLUSION Women in this long‐term research study with treated hypertension had a lower risk of falls compared with nonhypertensive women. Diastolic BP (but not systolic BP) is weakly associated with fall risk in women on antihypertensive treatment (<1% decrease in risk per mm Hg increase). J Am Geriatr Soc, 2019. J Am Geriatr Soc 67:726–733, 2019.

show abstract

“…The efficacy of vitamin D supplements to reduce risk of falls in individuals with low vitamin D levels has been previously shown (26). It is possible, as Bromfield et al (27) argues, that it is not the underlying diseases or the treatment itself but the existence of a fragility criterion.…”

Section: Discussionmentioning

confidence: 99%

Functional Evaluation Tests as Prognostic Factors of Falls in Elderly Patients

Benítez¹,

Ignacio²,

Perea³

et al. 2019

ejgg

View full text Add to dashboard Cite

Analysis of risk factors for falls through a detailed geriatric evaluation is essential. The aim of the present study was to analyze prognostic factors for falls in elderly patients in Spain. Materials and Methods: a) Initial phase (n=247): transverse observational study. Inclusion criteria: patients >80 years old living alone and/or with a relative of similar age; b) Final phase (n=90): prospective cohort study of the previously enrolled patients. Variables analyzed included demographics; clinical characteristics and results of timed up and go (TUG) (mobility assessment) and Lobo (cognitive assessment) tests; Lawton-Brody Instrumental Activities of Daily Living scale and Barthel index (basic activities). Results: Falls were significantly associated with changes in Lobo and Barthel test results during both phases. No association was found between falls and comorbidities, number or type of treatment received and analytical variables studied. No statistical difference was observed in TUG test between fallers and non-fallers in the initial phase. A significant deterioration was observed in Lobo, Lawton-Brody, Barthel and TUG evaluation tests during the 4-year in between-period; male gender and a lower score in Lobo test were independent variables related to mortality. In the final phase, a TUG cutoff value of 25 seconds (sensitivity=0.52; specificity=0.75), that differentiated fallers from non-fallers, was established. Conclusion: Tests that evaluate cognitive ability and functional activities are predictors of falls in the elderly. The use of Lobo test to define the cognitive state of elderly patients may contribute to predict their vital prognoses.

show abstract

Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension

Cited by 112 publications

References 31 publications

Association of masked uncontrolled hypertension and cardiovascular diseases in treated hypertensive patients

Association of masked uncontrolled hypertension and cardiovascular diseases in treated hypertensive patients

Hypertension Treatment and Control and Risk of Falls in Older Women

Functional Evaluation Tests as Prognostic Factors of Falls in Elderly Patients

Contact Info

Product

Resources

About