Citation

Robinson A. BMJ 2024; 385: q970.

Copyright

(Copyright © 2024, BMJ Publishing Group)

DOI

10.1136/bmj.q970

PMID

38697637

Abstract

Falls are common and dangerous for older and more vulnerable people. The main modifiable risk factor for falls is prescription drugs, and the most commonly prescribed drugs in older people are antihypertensives. The problem is that they can make people fall over when they stand up as orthostatic hypotension kicks in, especially in the immediate period after treatment is started.

This cohort study of nearly 30 000 nursing home residents, 97% of whom were men with a mean age of 78 years, found that, compared with a matched control group, initiation of antihypertensives was associated with an increased risk of fractures (5.4 v 2.2 per 100 person-years) and falls, especially among residents with dementia, high baseline blood pressures, and no recent antihypertensive treatment. The key question for clinicians is whether the expected cardiovascular benefits of treating hypertension are likely to outweigh the clear hazards of starting treatment.

Language: en

Keywords

*Accidental Falls/statistics & numerical data/prevention & control; *Antihypertensive Agents/therapeutic use/adverse effects; *Hypertension/drug therapy; Aged; Humans; Risk Factors