Citation

Bromfield SG, Ngameni CA, Colantonio LD, Bowling CB, Shimbo D, Reynolds K, Safford MM, Banach M, Toth PP, Muntner P. Hypertension 2017; 70(2): 259-266.

Affiliation

From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.). pmuntner@uab.edu.

Copyright

(Copyright © 2017, American Heart Assn)

DOI

10.1161/HYPERTENSIONAHA.116.09390

PMID

28652459

Abstract

Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99-1.40), 1.49 (95% confidence interval, 1.19-1.87), and 2.04 (95% confidence interval, 1.56-2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication.

© 2017 American Heart Association, Inc.

Language: en

Keywords

aged; blood pressure; falls; hypertension; polypharmacy