Aging Women’s Health: Correlation Between High Blood Pressure and Falls Uncovered
There is a common belief that long‐term, anti-hypertensive treatment may lead to an increased risk for falls and fractures, often leading to a conservative approach to treating hypertension in older adults. The Journal of the American Geriatrics Society recently published results from a prospective cohort study to assess the risk of falls in older women due to hypertension treatment. The study was comprised of a large, diverse population of older women enrolled in the Women’s Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health (OPACH) study.
The fall risk of the 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) in the study cohort was assessed while adjusting for:
- A range of systolic and diastolic blood pressure (BP) as measured by trained nurses,
- Hypertension status (no hypertension, untreated hypertension, treated controlled hypertension, treated uncontrolled hypertension) assessed by a medication inventory, and
- By antihypertensive drug class also assessed by the medication inventory.
Study participants self-reported falls for one year by submitting monthly calendars.
Study results: Women with treated, controlled hypertension had a statistically significant (15% to 20%) lower risk of falls than women with no hypertension. The level of systolic BP was not associated with falls in either the overall cohort or in women treated with antihypertensive medication.
- It is reasonable to monitor patients for an increased fall risk in the early period after starting a new antihypertensive drug or increasing the dosage.
- For patients who are doing well and tolerating the new treatment after the first several weeks, it appears the long‐term benefits of improved hypertension control can be achieved without an increased risk for falls.
Connection to Hendrich II Fall Risk Model®
The Hendrich research indicated that two drug classes always increase fall risk: antiepileptics (or anticonvulsants) and benzodiazepines. Patients who receive these medications have an increased fall risk due to the impact on the central nervous system and the drug side effects. Dizziness and vertigo can be common side effects of antihypertensive treatment and careful monitoring is required.
Margolis, K. L., Buchner, D. M., LaMonte, M. J., Zhang, Y., Di, C., Rillamas‐Sun, E. , Hunt, J., Ikramuddin, F., Li, W., Marshall, S., Rosenberg, D., Stefanick, M. L., Wallace, R. and LaCroix, A. Z., 2019. Hypertension Treatment and Control and Risk of Falls in Older Women. J Am Geriatr Soc, 67: 726-733. doi:10.1111/jgs.15732