title: Short-Term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment With Antihypertensive Medication.
abstract: Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls after antihypertensive medication initiation and intensification.
  
  
  
  We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90 127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007, and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the previous year. Intensification was defined by the addition of a new antihypertensive class, and separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days after antihypertensive medication initiation (odds ratio, 1.36 [95% confidence interval, 1.19-1.55]), adding a new class (odds ratio, 1.16 [95% confidence interval, 1.10-1.23]), and titration [odds ratio, 1.13 [95% confidence interval, 1.08-1.18]). These associations were attenuated beyond 15 days.
  
  
  
  Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults.
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.). ds2231@cumc.columbia.edu.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: C
authors.initials: C
authors.lastname: Barrett Bowling
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: Luqin
authors.initials: L
authors.lastname: Deng
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D018592:Cross-Over Studies; D016208:Databases, Factual; D054796:Drug Dosage Calculations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D006278:Medicare; D016017:Odds Ratio; D061214:Patient Safety; D004856:Postural Balance / Q000187:drug effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000959:Antihypertensive Agents
keywords: accidental falls; aged; antihypertensive agents; geriatrics