BP Meds May Cause Serious Falls in Some Elderly Patients

Some elderly patients may experience a higher risk of falling and suffering a serious injury in the weeks after initiating or increasing antihypertensive medication. According to researchers at Columbia University Medical Center, who published their findings this month in Circulation: Cardiovascular Quality and Outcomes, side effects caused by antihypertensive drug treatments could be to blame for the increased risk of falling.

Cardiologist Daichi Shimbo, MD, the study’s lead author, told Medscape, “If I'm initiating or intensifying meds, I may want to be careful in the short term, but after patients have been on the medications for a while, the risk has probably disappeared."

Some of the medication side effects Shimbo says could potentially increase the risk of falling and being seriously injured are dizziness, electrolyte abnormalities, postural hypotension and trouble balancing or walking. Other studies have failed to conclusively determine whether such side effects could increase the risk of falling because they were focused primarily on prevalences instead of whether the falls were linked to changes in blood pressure medication. Shimbo says his team’s study fills in the gap.

The team analyzed emergency and inpatient claims data between July 2007 and December 2012. They found 90,127 Medicare beneficiaries who suffered a serious injury as a result of a major fall. Serious injuries included brain injury; dislocation of the hip, knee, or jaw; and fractures of the facial bones, pelvis, and hip. They then checked to see if these injuries happened within 15 days of starting or increasing BP meds. They found that:

• 272 had begun antihypertensive meds
• 1,508 had added a new class of antihypertensive meds
• 3,113 had increased their dosage

The injuries were fatal within 90 days for 14 percent of those who started medication therapy. Slightly more than 15 percent of those who added meds suffered fatal injuries while 14.6 percent of those who increased their dosage experienced fatal injuries.

Based on the data, researchers say the risk of suffering a serious fall-related injury increases by 36 percent in the 15 days after starting or intensifying medication. Understanding this will help doctors know how to monitor patients in the weeks after starting medication therapy.

"If I were initiating or intensifying medications, I may want to keep a closer eye on the patient in the next 2 weeks, maybe with more clinical visits to make sure that they're tolerating their medication in the short term," Shimbo said.

To learn more, read the entire article.