What question did this study set out to answer?

To determine whether antihypertensive medication use and treatment intensity are associated with serious fall injuries in a nationally representative sample of older adults with hypertension.

February 24, 2014JAMA Internal MedicineOpen Access

Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults

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Why the study?

Does antihypertensive medication use increase the risk of serious fall injuries in community-living adults older than 70 years with hypertension?

Key Points

To determine whether antihypertensive medication use and treatment intensity are associated with serious fall injuries in a nationally representative sample of older adults with hypertension.
Analyzed 4961 community-living adults older than 70 years with hypertension from the Medicare Current Beneficiary Survey cohort across a 3-year follow-up through 2009.
Categorized antihypertensive intensity by standardized daily dose (14.1% nonusers, 54.6% moderate-intensity, 31.3% high-intensity) and evaluated serious fall injuries (major fractures, traumatic brain injuries, joint dislocations) using competing risk analysis and propensity score matching.
Across follow-up, 446 participants (9.0%) sustained serious fall injuries and 837 (16.9%) died; compared with nonusers, adjusted HRs for serious fall injury were 1.40 (95% CI, 1.03-1.90) for moderate-intensity and 1.28 (95% CI, 0.91-1.80) for high-intensity therapy.
Among 503 participants with a prior fall injury, adjusted HRs were 2.17 (95% CI, 0.98-4.80) for moderate-intensity and 2.31 (95% CI, 1.01-5.29) for high-intensity antihypertensive groups.

Structured PICO

Does antihypertensive medication use increase the risk of serious fall injuries in community-living adults older than 70 years with hypertension?

Population

4,961 community-living adults older than 70 years with hypertension from the nationally representative Medicare Current Beneficiary Survey cohort.

Intervention

Antihypertensive medication use (moderate-intensity and high-intensity based on standardized daily dose).

Comparator

No antihypertensive medications (nonusers).

Outcome

Serious fall injuries, including hip and other major fractures, traumatic brain injuries, and joint dislocations, ascertained through Centers for Medicare & Medicaid Services claims.safety

Antihypertensive medications are associated with an increased risk of serious fall injuries in older adults, highlighting the need to carefully weigh the harms and benefits of continuing treatment in those with multiple chronic conditions.

Discussion

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Implication

Antihypertensive use may increase serious fall injury risk in adults >70 years; leaves open causality and intensity effects for prospective trials.

Cite This Study

Tinetti et al. (2014) studied this question.

synapsesocial.com/papers/69d971db387cf7069868417c https://doi.org/10.1001/jamainternmed.2013.14764

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Implication

Antihypertensive use may increase serious fall injury risk in adults >70 years; leaves open causality and intensity effects for prospective trials.

Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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