Reexamining the Effect of Antihypertensive Medications on Falls in Old Age.
Conflicting data on the relationship between antihypertensive medications and falls in elderly people may lead to inappropriate undertreatment of hypertension in an effort to prevent falls. We aimed to clarify the relationships between the chronic use of different classes of antihypertensive medications and different types of falls, to determine the effect of medication dose, and to assess whether the risk of falls is associated with differences in cerebral blood flow. We assessed demographics, clinical characteristics, and chronic antihypertensive medication use in 598 community-dwelling people with hypertension, aged 70 to 97 years, then followed them prospectively for self-reported falls using monthly calendar postcards and telephone interviews. Antihypertensive medication use was not associated with an increased risk of falls. Participants reporting use of angiotensin-converting enzyme inhibitors had a significantly decreased 1-year risk of injurious falls (odds ratio, 0.62; 95% confidence interval, 0.39-0.96), whereas those using calcium channel blockers had a decreased risk of all falls (odds ratio, 0.62; 95% confidence interval, 0.42-0.91) and indoor falls (odds ratio, 0.57; 95% confidence interval, 0.36-0.91), compared with participants not taking these drugs. Larger doses of these classes were associated with a lower fall risk. Participants taking calcium channel blockers had higher cerebral blood flow than those not taking these medications. In relatively healthy community-dwelling elderly people, high doses of antihypertensive agents are not associated with an increased risk of falls.
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.). Lipsitz@hsl.harvard.edu.
Lewis A
LA
Lipsitz
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Daniel
D
Habtemariam
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Margaret
M
Gagnon
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Ikechukwu
I
Iloputaife
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Farzaneh
F
Sorond
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Achille E
AE
Tchalla
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Thierry F
TF
Dantoine
From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
Thomas G
TG
Travison
D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004198:Disease Susceptibility; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
aged; angiotensin-converting enzyme inhibitors; antihypertensive agents; blood flow velocity; calcium channel blockers