Citation

Canales MT, Shorr RI. JAMA Intern. Med. 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, American Medical Association)

DOI

10.1001/jamainternmed.2024.0506

PMID

38648066

Abstract

In this study, Dave et al1 harness national Veterans Health Administration (VHA) clinical data to examine the association between initiation of a new antihypertensive agent with the incidence of fall-related fractures in residents at VHA nursing homes, or community living centers. In this carefully designed study, residents who received a new antihypertensive agent had more than 2-fold greater risk of fractures compared with those who did not (adjusted hazard ratio [aHR], 2.42 [95% CI, 1.43-4.08]). This practice was also associated with 1.8-fold greater risk of serious falls (HR, 1.80 [95% CI, 1.52-2.13]) and 1.7-fold greater risk of syncope (HR, 1.69 [95% CI, 1.30-2.19]). Subgroup analysis revealed an even higher risk of fractures in nursing home residents with dementia (HR, 3.28 [95% CI, 1.76-6.10]), elevated systolic (HR, 3.12 [95% CI, 1.71-5.69]) or diastolic (HR, 4.41 [95% CI, 1.67-11.68]) blood pressure, and those who had not used antihypertensives (HR, 4.77 [95% CI, 1.49-15.32]). These findings create a compelling narrative that rapidly decreasing blood pressure in nursing home residents may cause orthostatic hypotension, leading to falls and fractures. They also extend the findings from a smaller study of participants in the Systolic Blood Pressure Intervention Trial (SPRINT).2 In a secondary analysis of SPRINT, participants randomized to intensive treatment of systolic hypertension (blood pressure <120 mm Hg) were more likely to experience hypotension, and possibly syncope, but not falls...

Language: en