Short-Term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment With Antihypertensive Medication.

Academic Article

Abstract

  • BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults.
  • Keywords

  • accidental falls, aged, antihypertensive agents, geriatrics, Accidental Falls, Age Factors, Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Cross-Over Studies, Databases, Factual, Drug Dosage Calculations, Drug Therapy, Combination, Female, Humans, Hypertension, Logistic Models, Male, Medicare, Odds Ratio, Patient Safety, Postural Balance, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States
  • Digital Object Identifier (doi)

    Author List

  • Shimbo D; Barrett Bowling C; Levitan EB; Deng L; Sim JJ; Huang L; Reynolds K; Muntner P
  • Start Page

  • 222
  • End Page

  • 229
  • Volume

  • 9
  • Issue

  • 3