Risk Is Highest Within 1st Month of Treatment
Unintentional injuries are the fifth leading cause of death among older adults, with falls causing two-thirds of those injuries, according to the study. Nursing home residents receiving long-term care are especially vulnerable to such injuries due to their often having multiple conditions, being on multiple medications, and being frail. Most people living in long-term care facilities will experience a fall any given year; 25 percent of those falls will lead to serious injury, and between 10 percent and 15 percent will result in fracture, hospitalization, or death.When first initiated, blood pressure-lowering drugs pose an increased risk of falls for residents living in health care facilities. The research team noted that more than 70 percent of older adults are diagnosed with hypertension, adding that blood pressure-lowering therapies are the most commonly used medications in the older population.
“Taken together, these findings suggest that frail older nursing home residents are more likely to experience a fall and with each fall are more likely to experience fractures,” the research team theorized.
The study’s findings supported this theory. The research team reviewed data from the Veterans Health Administration of nearly 30,000 long-term nursing home care residents between Jan. 1, 2006, and Oct. 31, 2019. Patients were at least 65 years old (average age 78), without end-stage kidney disease, and had at least one documented measure of blood pressure within the timeframe. Using propensity score matching, researchers compared the data to a cohort of nearly 65,000 residents, averaging 78 years old, who did not change their medication regimen.
The researchers found that starting antihypertensive medications was associated with an increased rate of fractures. The average rate of fractures for individuals on antihypertensive medications was 5.4 for every 100 people; the rate was nearly half that (2.2 per 100 people) for individuals who hadn’t changed their medication.
Residents who had recently started antihypertensive medication had a more than twofold greater risk of fracture than those who had not and a 1.8-fold greater risk of a serious fall. During follow-up, the researchers found that the most common outcomes were nontraumatic fractures to the humerus, hip, pelvis, radius, or ulna within 30 days of beginning antihypertensive medication.
“Findings from this cohort study suggest that caution and additional monitoring are advised when initiating antihypertensive medication in this vulnerable population,” the research team wrote.
Rapidly Lowering Blood Pressure Could Cause Orthostatic Hypotension
In a corresponding commentary, Dr. Muna Thalji Canales, a nephrologist, and Dr. Ronald Shorr from the Malcom Randall VA Medical Center in Gainesville, Florida, added that the findings create a “compelling narrative that rapidly decreasing blood pressure in nursing home residents may cause orthostatic hypotension, leading to falls and fractures.” Orthostatic hypotension is a sudden drop in blood pressure when one stands up, which can result in dizziness or fainting.Drs. Canales and Shorr urged for more monitoring of these vulnerable patients.
“In a perfect world, orthostatic vitals would be monitored around changes in blood pressure management, particularly in the first week after a change or with introduction of a new class of drug,” they wrote. “Vital signs could be monitored more frequently, at least with each shift change. Also, health care practitioners at nursing homes might avoid rapid intensification of antihypertensive medication—perhaps allowing at least a month for acclimation to a new dose or drug.”
