Injurious Falls and Syncope in Older Community-Dwelling Adults Meeting Inclusion Criteria for SPRINT

Sexton, Donal J.; Canney, Mark; O’Connell, Matthew; Moore, Patrick; Little, Mark A.; O’Seaghdha, Conall M.; Kenny, Rose Anne

doi:10.1001/jamainternmed.2017.2924

Cited by 58 publications

(38 citation statements)

References 5 publications

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“…), most NH residents and geriatrics patients have greater disease and function burden, higher fall rates, and worse survival than that study's subjects (Sexton et al. ). Since hypertension is the most common chronic condition among NH residents in the United States, with 54 percent of all residents affected (Simonson, Han, and Davidson ), the potential impact of new evidence is great.…”

Section: Discussionmentioning

confidence: 89%

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Antihypertensive Drug Deintensification and Recurrent Falls in Long‐Term Care

Song

Intrator

Lee

et al. 2018

Health Services Research

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Objective To examine the relationship between antihypertensive drug deintensification and recurrent falls in long‐term care. Data Sources/Settings Department of Veterans Affairs (VA) inpatient, outpatient, and purchased care data, Minimum Data Set assessments from VA nursing homes (NHs), and Medicare claims from fiscal years 2010 – 2015. Study Design We identified NH residents with evidence of overaggressive antihypertensive treatment, defined as systolic blood pressure (SBP) 80–120 and an index fall. Recurrent fall, hospitalization, and mortality within 30 days were compared between veterans whose antihypertensive medications were deintensified versus those whose antihypertensive medications were not using propensity score methods (PSM). Principal Findings Among 2,212 NH residents with possibly overaggressive antihypertensive treatment, 11 percent experienced antihypertensive drug deintensification. Lower blood pressure, >1 antihypertensive drug, no congestive heart failure, fracture from index fall, and older age were associated with higher likelihood of deintensification. Antihypertensive deintensification was associated with statistically significant (p‐value < .01) lower risk of recurrent fall among residents with SBP 80–100 (marginal effect = −11.4 percent; PSM = −13.6 percent) and higher risk of death among residents with SBP 101–120 (marginal effect = 2.1 percent, p‐value = .07; with PSM = 4.3 percent, p‐value = .04). Conclusions Results provide some needed evidence and guidelines for deintensifying antihypertensive medication among frail older residents; since hypertension is prevalent among 54 percent of NH residents, the potential impact of new evidence is great.

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Section: Discussionmentioning

confidence: 89%

“…; Sexton et al. ; Williamson et al. ), with such harms leading to higher long‐term mortality risk (Benetos et al.…”

mentioning

confidence: 99%

Antihypertensive Drug Deintensification and Recurrent Falls in Long‐Term Care

Song

Intrator

Lee

et al. 2018

Health Services Research

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“…However, the external validity of this finding is questionable. A nationally representative longitudinal study of older adults meeting the SPRINT inclusion criteria observed a fivefold higher rate of injurious falls than the standard care group within SPRINT during a comparable follow-up period 49. Furthermore, it is apparent that medication adherence of clinical trial participants is higher.…”

Section: Discussionmentioning

confidence: 99%

Association between gaps in antihypertensive medication adherence and injurious falls in older community-dwelling adults: a prospective cohort study

et al. 2019

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ObjectiveGrowing evidence suggests that older adults are at an increased risk of injurious falls when initiating antihypertensive medication, while the evidence regarding long-term use of antihypertensive medication and the risk of falling is mixed. However, long-term users who stop and start these medications may have a similar risk of falling to initial users of antihypertensive medication. Our aim was to evaluate the association between gaps in antihypertensive medication adherence and injurious falls in older (≥65 years) community-dwelling, long-term (≥≥1 year) antihypertensive users.DesignProspective cohort study.SettingIrish Community Pharmacy.ParticipantsConsecutive participants presenting a prescription for antihypertensive medication to 106 community pharmacies nationwide, community-dwelling, ≥65 years, with no evidence of cognitive impairment, taking antihypertensive medication for ≥1 year (n=938).MeasuresGaps in antihypertensive medication adherence were evaluated from linked dispensing records as the number of 5-day gaps between sequential supplies over the 12-month period prior to baseline. Injurious falls during follow-up were recorded via questionnaire during structured telephone interviews at 12 months.ResultsAt 12 months, 8.1% (n=76) of participants reported an injurious fall requiring medical attention. The mean number of 5-day gaps in medication refill behaviour was 1.47 (SD 1.58). In adjusted, modified Poisson models, 5-day medication refill gaps at baseline were associated with a higher risk of an injurious fall during follow-up (aRR 1.18, 95% CI 1.02 to 1.37, p=0.024).ConclusionEach 5-day gap in antihypertensive refill adherence increased the risk of self-reported injurious falls by 18%. Gaps in antihypertensive adherence may be a marker for increased risk of injurious falls. It is unknown whether adherence-interventions will reduce subsequent risk. This finding is hypothesis generating and should be replicated in similar populations.

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“…57 It has been proposed that injurious falls and syncope incidence may have been underreported in interventional studies such as SPRINT. 58 In this context, bedtime administration of antihypertensive treatment, addressing both supine hypertension and an increased risk of BP fall during morning hours, seems to be less harmful, more optimal in reducing CV risk, and might be a standard approach in the future. 59 Finally, it is important to acknowledge that the identification of any optimum SBP therapeutic goal must Together with increased arterial stiffness, LVH is likely to be responsible for the impaired diastolic function in patients with OH.…”

Section: Cardiovascular Risk Factors and Circulatory Compli-mentioning

confidence: 99%

Orthostatic hypotension and cardiovascular risk

Fedorowski¹,

Ricci²,

Sutton³

2019

Kardiol Pol

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Orthostatic hypotension (OH) is a cardinal sign of cardiovascular (CV) autonomic dysfunction as a result of autonomic nervous system failure to control the postural hemodynamic homeostasis. The proportion of individuals with OH increases with aging and chronic conditions, such as neurodegenerative diseases, hypertension, heart failure, diabetes, renal dysfunction, autoimmune diseases, and cancer. In individuals over 70 years of age, more than 20% can be affected. It is now increasingly recognized that there is a direct relationship between OH and each step of the CV disease continuum, eventually leading to end-stage heart disease and CV death. In particular, prevalent OH is associated with cardiac functional and structural remodeling, left ventricular hypertrophy, elevated levels of circulating markers of inflammation, increased intima-media thickness, subclinical atherosclerosis, and thrombosis. Beyond subclinical changes, the presence of OH independently predicts coronary events, stroke, atrial fibrillation, heart failure, and CV mortality. Furthermore, OH is associated with syncope, falls, and fragility fractures, presenting hurdles to be overcome in the delivery of the best management of CV risk factors. Taken together, OH heralds disruption of global circulatory homeostasis and flags overt autonomic dysfunction. The presence of OH is also an independent risk factor for mortality and CV disease; however, until now, the importance of this highly prevalent disorder has been given insufficient attention by clinicians and other healthcare providers. Consequently, more studies are needed to find effective treatment for this troublesome condition and to identify preventive measures that could reduce the burden of CV risk in OH and autonomic dysfunction.

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Injurious Falls and Syncope in Older Community-Dwelling Adults Meeting Inclusion Criteria for SPRINT

Abstract: Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Cited by 58 publications

References 5 publications

Antihypertensive Drug Deintensification and Recurrent Falls in Long‐Term Care

Antihypertensive Drug Deintensification and Recurrent Falls in Long‐Term Care

Association between gaps in antihypertensive medication adherence and injurious falls in older community-dwelling adults: a prospective cohort study

Orthostatic hypotension and cardiovascular risk

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