March 3, 2014

For Older Hypertension Patients, An Unwelcome Tradeoff

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Seniors who take blood pressure medications have a greater risk of falling and suffering hip fractures and other injuries, a new Yale School of Medicine study shows.

Though the drugs help to lower the risk of strokes and heart attacks, the reduction in risk may be offset by an increased risk of serious injuries from falls, said Dr. Mary Tinetti, chief of geriatrics at Yale School of Medicine and an author of the new study, published in JAMA Internal Medicine.

“Older patients and their clinicians need to weigh the harms as well as the benefits in prescribing medications, particularly when the harms may be at least as serious as the diseases and events we hope the medications prevent,” Tinetti said.

Clinicians have long assumed that blood pressure medications are safe and effective in all older adults. While likely true in healthy older adults, that might not be the case in a more typical population of older adults, who often have other chronic conditions, the researchers say.

The study of about 5,000 patients older than 70 with hypertension found that those who were taking antihypertensive medications had a 30 to 40 percent greater likelihood of experiencing severe fall-related injuries such as hip fractures and head trauma.

“Although no single study can settle the question, and we cannot exclude the possibility that factors other than the medications accounted for the increased risk of injury, these medications may be more harmful in some individuals than thought,” Tinetti said.

Fall-related injuries such as hip fractures are among the most common and expensive health conditions experienced by older adults. Falls account for 10 percent of emergency department visits and 6 percent of hospitalizations among those over age 65. Falls also can lead to functional decline, placement in a nursing home, restricted activity –and death.

In Connecticut, hospital and nursing home associations have been working on a number of initiatives to reduce falls among the elderly, which have been an ongoing concern. The state’s death rate from falls among people aged 65 and older was 49.74 per 100,000 in 2004-10 – higher than the national rate of 48.12, according to the CDC.

Tinetti said patients might find themselves “in the tough position of either choosing to continue their blood pressure medication and risk side effects that could lead to life-altering falls, or discontinuing their medications and risk heart attacks and stroke.”

 

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