Hypertension Treatment and Control and Risk of Falls in Older Women

Abstract

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.

Características sociodemográficas, clínicas y farmacológicas de adultos mayores con fracturas, en tres centros de referencia, Colombia

“…Un poco más de la mitad de los pacientes con fracturas se encontraba en tratamiento con antihipertensivos, lo que podría aumentar el riesgo de hipotensión como reacción adversa y asociarse con caídas (26,27); sin embargo en el presente estudio no se obtuvieron las cifras tensionales al ingreso. De otro lado, la diabetes mellitus también puede asociarse con riesgo de caídas debido a complicaciones agudas o crónicas, y al riesgo de hipoglicemias que se puede presentar con los medicamentos empleados (28), sin embargo no se obtuvieron estudios paraclínicos para corroborar lo anterior.…”

Influence of Drugs of Continuous Use on the Sensory Regulation of the Static Balance of Elderly Regular Practitioners of the Pilates Method

“…We found statistically significant results for self-reported comorbidities, such as arterial hypertension, which showed a prevalence of 75% for the faller group. The finding serves as an alert for adverse effects caused by antihypertensive drugs, including orthostatic hypotension, syncope and dizziness 31,32 .…”

“…Its hypotensive action comes from the reduction of the activity of the renin-angiotensin-aldosterone system caused by the β1 receptor blockade in the juxtapoclarular renal cells. Nebivolol can also cause orthostatic hypotension in response to changes induced by intravascular volume severity due to negative inotropic and chronotropic effects of β1 blockers 36 . All of this reduces the capacity of the heart to increase heart rate and cardiac output, increasing the risk of falls 33 .…”

Prevalence and risk factors of falls among community-dwelling older people: results from three consecutive waves of the national health interview survey in Taiwan

“…The finding that older asthmatic patients presented a high rate of falls [41] is comparable with that of patients with chronic obstructive pulmonary disorder (COPD) [42] might be related to skeletal muscle dysfunction and cerebral hypoxemia [33]. The escalation of risk of falls among hypertensive patients might result from hypotension induced by stringent control of blood pressure or from early initiation or intensification of antihypertensive therapy [43]. Moreover, our finding in the fall-risk gradient among older people having one or two or more comorbidities is not only consistent with that of Qin and Baccaglini [44], but also strengthens the assertion of the additive effect of chronic disease on fall risk [33].…”