Hypertension, Antihypertensive Drugs and the Risk of Fractures

Butt, Debra A.; Alharty, Raghad; Leu, Richard K. Le; Cheung, Angela M.

doi:10.1007/s12018-015-9191-z

Cited by 3 publications

(5 citation statements)

References 48 publications

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“…Men with hypertension who did not use ARBs or ACEIs were also at an increased risk for fracture but this did not reach significance. This result is not unexpected, as previous literature suggests an increased risk of fracture in the presence of hypertension [ 4 , 35 ]. No other associations were detected for men.…”

Section: Discussionsupporting

confidence: 81%

“…These groups were created because hypertension status has previously been reported to affect fracture risk [4].…”

Section: Discussionmentioning

confidence: 99%

“…In analyses, non-users without hypertension (group 1) were set at the referent group. These groups were created because hypertension status has previously been reported to affect fracture risk [ 4 ].…”

Section: Methodsmentioning

confidence: 99%

“…Although hypertension is not considered an independent risk factor for fracture, it has been suggested to be associated with an increased risk. A potential mechanism for this has been described, whereby individuals with hypertension have a net loss of calcium due to increased urinary excretion as well as reduced absorption [ 4 , 5 ]. This can then lead to increased activation of parathyroid tissue and a net loss of calcium from the bones [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

et al. 2022

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Medications used to treat hypertension may affect fracture risk. This study investigated fracture risk for users of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Participants (899 men, median age 70.3 yr (59.9–79.1), range 50.0–96.6 yr; 574 women, median age 65.5 yr (58.1–75.4), range 50.1–94.6 yr) were from the Geelong Osteoporosis Study. Medication use was self-reported and incident fractures were ascertained using radiological reports. Bone mineral density (BMD) was measured at the femoral neck. Participants were divided into four groups: (1) non-users without hypertension, (2) non-users with hypertension, (3) ACEI users and (4) ARB users. Dosage was calculated using the defined daily dose (DDD) criteria. Participants were followed from date of visit to first fracture, death or 31 December 2016, whichever occurred first. Cox proportional hazards models were used for analyses. At least one incident fracture was sustained by 156 men and 135 women over a median(IQR) of 11.5(6.2–13.2) and 10.9(6.3–11.6) years of follow-up, respectively. In unadjusted analyses, compared to non-users without hypertension, men in all three other groups had a higher risk of fracture (Hazard Ratio (HR, 95%CI) 1.54, 1.00–2.37; 1.90, 1.18–3.05; 2.15, 1.26–3.66), for non-users with hypertension, ACEI and ARB users, respectively). Following adjustment for age, prior fracture and BMD, these associations became non-significant. A dose effect for ARB use was observed; men using lower doses had a higher risk of fracture than non-users without hypertension, in both unadjusted (2.66, 1.34–5.29) and adjusted (2.03, 1.01–4.08) analyses, but this association was not observed at higher doses. For women, unadjusted analyses showed a higher risk for ACEI users compared to non-users without hypertension (1.74, 1.07–2.83). This was explained after adjustment for age, alcohol consumption, prior fracture and BMD (1.28, 0.74–2.22). No other differences were observed. In men, lower dose (0 < DDD ≤ 1) ARB use was associated with an increased risk of fracture. ACEI or ARB use was not associated with increased risk of incident fracture in women. These findings may be important for antihypertensive treatment decisions in individuals with a high risk of fracture.

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Section: Discussionsupporting

confidence: 81%

“…These groups were created because hypertension status has previously been reported to affect fracture risk [4].…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

et al. 2022

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“…Both arterial hypertension and osteoporosis show increased frequency in aging, especially in post-menopausal women, and share the same risk factors, such as low physical activity or smoking. These two diseases have similar pathophysiological mechanisms, such as increased oxidative stress, inflammation, and dysfunctions of calcium homeostasis [ 5 , 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Angiotensin II Modulates Calcium/Phosphate Excretion in Experimental Model of Hypertension: Focus on Bone

et al. 2022

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A link between hypertension and long-term bone health has been suggested. The aim of this study was to investigate the effects of chronic angiotensin II administration on urinary calcium/phosphate excretion, bone mineral density, bone remodeling and osteoblast population in a well-established experimental model of hypertension, in the absence of possible confounding factors that could affect bone metabolism. Male Sprague–Dawley rats, divided in the following groups: (a) Angiotensin II (Ang II, 200 ng/kg/min, osmotic minipumps, sub cutis, n = 8); (b) Ang II+losartan (Los, 50 mg/kg/day, per os, n = 6); (c) control group (physiological saline, sub cutis, n = 9); and (d) control+losartan (n = 6) were treated for four weeks. During the experimental period, 24-hour diuresis, urinary calcium, phosphate and sodium excretion were measured prior to the treatment, at two weeks of treatment, and at the end of the treatment. Systolic blood pressure was measured by plethysmography technique (tail cuff method). At the end of the experimental protocol, the rats were euthanized and peripheral quantitative computed tomography at the proximal metaphysis and at the diaphysis of the tibiae and quantitative bone histomorphometry on distal femora were performed. Angiotensin II-dependent hypertension is associated with increased calcium and phosphate excretion. AT1 receptor blockade prevented the increase of blood pressure and phosphate excretion but did not affect the increase of calcium excretion. These changes took place without significantly affecting bone density, bone histology or osteoblast population. In conclusion, in our experimental conditions, angiotensin II-dependent hypertension gave rise to an increased urinary excretion of calcium and phosphate without affecting bone density.

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Association between bone measures and use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

et al. 2021

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Hypertension, Antihypertensive Drugs and the Risk of Fractures

Cited by 3 publications

References 48 publications

Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

Angiotensin II Modulates Calcium/Phosphate Excretion in Experimental Model of Hypertension: Focus on Bone

Association between bone measures and use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

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