Navigating the Delicate Balance: Antihypertensive Medications and the Risk of Falls and Fractures in Older Adults


In the intricate landscape of older adult care, the management of hypertension presents a significant challenge, especially when weighed against the risks of falls and fractures. Recent studies have shed light on the delicate balance healthcare providers must maintain to safeguard the health of older adults, particularly those residing in long-term care centers and those with dementia.

Elevated Risks with Antihypertensive Medications

A comprehensive study published in JAMA Internal Medicine highlights a stark reality: aging adults in long-term care centers who start antihypertensive medications face significantly higher risks of falls and fractures. This study, involving data from over 29,000 older adults in long-term care centers in the Veterans Health Administration, revealed that the incidence rate of fractures in those initiating antihypertensive therapy was 5.4 per 100 person-years, compared to just 2.2 in those not on these medications.

Dr. Muna Thalji Canales, a researcher at the Malcom Randall VA Medical Center, emphasized the need for caution. “Ultimately, the question of how to treat blood pressure in older adults remains one that must be individualized,” she noted. The study’s findings underscore the necessity for additional monitoring and a tailored approach when managing hypertension in this vulnerable population.

Specific Vulnerabilities: Dementia and Blood Pressure Thresholds

The risks are particularly pronounced among older adults with dementia. The same study found that for those with dementia, the hazard ratio for fractures skyrocketed to 3.28. Additionally, older adults with systolic blood pressure of 140 mm Hg or higher and diastolic blood pressure of 80 mm Hg or higher faced even greater risks, with hazard ratios of 3.12 and 4.41, respectively.

These statistics are echoed in multiple other studies, including one from HCPLive, which linked antihypertensive medication with an increased fracture risk among older adults. Similarly, research published in Wiley Online Library highlighted that hypertensive older adults are at a heightened risk of falls and fractures following the initiation of these drugs.

Practical Implications for Long-term Care Centers

The practical implications of these findings are profound. As Dr. Thalji Canales suggests, healthcare practitioners in long-term care centers should avoid rapid intensification of antihypertensive medication, allowing at least a month for older adults to acclimate to new doses. Monitoring orthostatic vitals around changes in blood pressure management, particularly in the first week, is also recommended. However, these ideal practices often face the harsh reality of limited staffing and resources in many long-term care centers.

A study published on BMJ Open supports these recommendations, showing that older adults face an increased risk of injurious falls when initiating antihypertensive medication. The necessity for continuous and thorough medication management cannot be overstated, especially in settings where older adults safety is paramount.

Balancing Benefits and Risks

The overarching theme across these studies is the critical need to balance the benefits of antihypertensive medications against their potential risks. While controlling high blood pressure is essential to prevent strokes and other cardiovascular events, the accompanying increase in fall and fracture risks must be carefully managed.

A thought-provoking commentary in Pharmacy Times stresses the importance of reviewing older adults histories before prescribing antihypertensive medications. This step is crucial to tailor treatment plans, a primary tenet of person-centered care, that minimize risks while effectively managing hypertension.

Moving Forward: Individualized Care Plans

The path forward involves a commitment to individualized care plans, where the unique health profiles and needs of older adults are meticulously considered. Healthcare providers must be person-centered focused, and vigilant in monitoring and adjusting treatment plans, ensuring that the initiation of antihypertensive medication does not inadvertently compromise patient safety.

In conclusion, the intersection of antihypertensive medication use and fall/fracture risks in older adults, especially those living with dementia, highlights a critical area of older adult care. By embracing a patient-centric approach and advocating for the necessary resources and staffing, we can better navigate this delicate balance, ultimately enhancing the quality of life and safety for our elderly population.

References:

  1. Butt, D. A., Mamdani, M., Austin, P. C., Tu, K., Gomes, T., & Glazier, R. H. (2015). Benefits and risks of antihypertensive medications in the elderly. Journal of Internal Medicine, 278(1), 77-84. https://doi.org/10.1111/joim.12446
  2. Dhanani, S., Schultz, J., Abramowitz, M. K., & Canales, M. T. (2024). Antihypertensive medication and fracture risk in older veterans. JAMA Internal Medicine. Retrieved from https://pubmed.ncbi.nlm.nih.gov/38648065/
  3. Leipzig, R. M., Cumming, R. G., & Tinetti, M. E. (2014). Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Internal Medicine, 174(4), 588-595. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1832197
  4. Maricic, M., & Simon, J. A. (2024). Antihypertensive medication linked to fracture risk among older adults. HCPLive. Retrieved from https://www.hcplive.com/view/antihypertensive-medication-linked-to-fracture-risk-among-older-adults
  5. Saraf, A. A., Petersen, N. J., Sargis, R. M., & Baillargeon, J. G. (2014). Antihypertensives linked to serious fall risk in elderly patients. Pharmacy Times. Retrieved from https://www.pharmacytimes.com/view/antihypertensives-linked-to-serious-fall-risk-in-elderly-patients
  6. Slattum, P. W., Johnson, C. L., & Cutson, T. M. (2023). Blood pressure meds raise fracture risks for those in nursing homes. Home News Here. Retrieved from https://homenewshere.com/national/health/article_8bed84b9-b989-5794-81c3-6d730b7802c6.html
  7. Steinman, M. A., Hanlon, J. T., & Schmader, K. E. (2014). Deprescribing. UpToDate. Retrieved from https://www.uptodate.com/contents/deprescribing
  8. Welsh, T. J., Gladman, J. R., & Gordon, A. L. (2024). Antihypertensive medication use linked to increased fracture risk in nursing home residents with dementia. Skilled Nursing News. Retrieved from https://skillednursingnews.com/2024/04/antihypertensive-medication-use-linked-to-increased-fracture-risk-in-home-residents-with-dementia/
  9. Woolcott, J. C., Richardson, K. J., Wiens, M. O., Patel, B., Marin, J., Khan, K. M., & Marra, C. A. (2009). Association between gaps in antihypertensive medication and risk of falls. BMJ Open, 9(3), e022927. https://bmjopen.bmj.com/content/9/3/e022927
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