title: Angiotensin system-blocking medications are associated with fewer falls over 12 months in community-dwelling older people.
abstract: OBJECTIVE
  To investigate relationships between the use of cardiovascular medications, including angiotensin system-blocking medications (ASBMs), orthostatic hypotension (OH), fall risk, and falls in community-dwelling older people.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Sydney, Australia.
  
  
  METHODS
  Five hundred twenty community-dwelling older adults.
  
  
  METHODS
  Medical, medication and falls history were obtained from a standardized questionnaire in all participants. Blood pressure was measured in supine, seated, and tilted positions. Fall risk was assessed using the Physiological Profile Assessment (PPA). Falls data were collected prospectively for 12 months using monthly fall calendars. Participants were defined as nonfallers (no falls) and fallers (≥ 1 falls) at the end of the 12-month follow-up.
  
  
  RESULTS
  Participants taking medications affecting the angiotensin system had greater quadriceps strength, but after adjusting for sex, this difference became insignificant. People taking ASBMs were less likely to fall (odds ratio = 0.68, 95% confidence interval = 0.48-0.97), and the association between ASBMs and falls remained significant after adjusting for sex, body mass index, PPA score, and psychotropic medication and 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor (statin) use. OH was more frequently observed in participants taking alpha adrenergic receptor blockers (α-blockers), but the presence of OH did not increase fall risk.
  
  
  CONCLUSIONS
  The use of cardiovascular medications in older people did not increase the risk of falls, and the use of ASBMs was associated with lower fall risk. The mechanisms for this apparent protective effect are unclear and appear not to be directly related to muscle strength. More research is required to elucidate the possible protective effects of certain cardiovascular medications in relation to falls in older people.
authors: Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
authors: Alfred K W
authors: AK
authors: Wong
authors: Stephen R
authors: SR
authors: Lord
authors: Daina L
authors: DL
authors: Sturnieks
authors: Kim
authors: K
authors: Delbaere
authors: Julian N
authors: JN
authors: Trollor
authors: Jacqueline C T
authors: JC
authors: Close
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053580:Muscle Strength / Q000187:drug effects; D009517:New South Wales / Q000453:epidemiology; D004856:Postural Balance / Q000187:drug effects*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors