Past research indicates an elevated risk of falling associated with antihypertensive medications, although no data is readily available regarding the short-term threat following commencement and escalation of treatment. Recently, the University of Alabama at Birmingham department of epidemiology’s Dr. Emily B. Levitan, associate professor (pictured); Ms. Luqin Deng and Ms. Lei Huang, statisticians; and Dr. Paul Muntner, professor and vice chair, teamed with lead author Dr. Daichi Shimbo, associate professor at Columbia University Medical Center; Dr. C. Barrett Bowling, assistant professor at Emory University; Dr. John J. Sim, at Kaiser Permanente; and Dr. Kristi Reynolds, associate director of epidemiologic research at Kaiser Permanente Research, in a case-crossover study of 90,127 Medicare beneficiaries (ages 65 and older) designed to examine serious injuries as a result of falls occurring between July 1, 2007, and December 31, 2012. Initiation of treatment was defined by a filled prescription (with no refills in the previous 12 months); intensification was defined as either supplementing with an additional antihypertensive or an increased dosage of the current medication.
[Photo: Dr. Emily B. Levitan]
The researchers documented that “exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272; 1,508; and 3,113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days after antihypertensive medication initiation (odds ratio, 1.36 [95 percent confidence interval, 1.19–1.55]), adding a new class (odds ratio, 1.16 [95 percent confidence interval, 1.10–1.23]), and titration [odds ratio, 1.13 [95 percent confidence interval, 1.08–1.18]). These associations were attenuated beyond 15 days.” They concluded that commencement and escalation of antihypertensive medication was linked with short- rather than long-term elevated risk of serious falls among older patients.
“Short-Term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment With Antihypertensive Medication” was published in April in Circulation: Cardiovascular Quality and Outcomes.