Association between gaps in antihypertensive medication adherence and injurious falls in older community-dwelling adults: a prospective cohort study

Dillon, Paul; Smith, Susan M; Gallagher, Paul; Cousins, Gráinne

doi:10.1136/bmjopen-2018-022927

Cited by 13 publications

(6 citation statements)

References 55 publications

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“…This observed association is similar to a prospective cohort study of 938 patients of community pharmacies in Ireland, whereby each 5-day gap in antihypertensive medication adherence increased the risk of self-reported falls by 18%. 32 It is possible that being adherent to antihypertensive medications may have reduced BP variability in patients, which led to the observed reduction in the risk of falls. 33 Alternatively, those who adhered to their medications may have also participated in other healthy behaviors (eg, regular physical activity, healthy diet and regular healthcare attendance) which contributed to fewer observed falls.…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive Medication Adherence and the Risk of Vascular Events and Falls After Stroke: A Real-World Effectiveness Study Using Linked Registry Data

et al. 2023

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BACKGROUND: Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke. METHODS: A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012–2016; Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome; and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for >30 confounders using inverse probability treatment weights. RESULTS: Among 4076 eligible participants (median age 68 years; 37% women), 58% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68; 95% CI: 0.54–0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78; 95% CI: 0.62–0.98) than those with a proportion of days covered <80%. CONCLUSIONS: High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.

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Section: Discussionmentioning

confidence: 99%

Antihypertensive Medication Adherence and the Risk of Vascular Events and Falls After Stroke: A Real-World Effectiveness Study Using Linked Registry Data

et al. 2023

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“…Although consecutive recruitment involves non-probabilistic sampling, it provides structured recruitment ensuring all participants can be enrolled, thus producing a more representative sample of the target population than convenience sampling. 26 27 Furthermore, the use of POSAMINO criteria, which focus on potentially serious alcohol–medication interactions, avoids overestimating risk by excluding those interactions, which are of limited clinical significance. In addition, medication use was evaluated objectively using pharmacy dispensing records.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

et al. 2020

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ObjectivePrevious prevalence estimates of POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared with dispensing records. This study aims to estimate the prevalence of POSAMINO among community-dwelling older adults using drug dispensing data from the community pharmacy setting.DesignCross-sectional study.SettingIrish Community Pharmacy.Participants1599 consecutive older adults presenting with a prescription to 1 of 120 community pharmacies nationwide; community-dwelling, aged ≥65 years, able to speak and understand English, with no evidence of cognitive impairment. The mean age of sample was 75.5 years (SD 6.5); 55% (n=884) female.Measures38 POSAMINO criteria were identified using participants’ pharmacy dispensing records linked to self-reported alcohol consumption (beverage-specific quantity and frequency measures) over the last 12 months.ResultsThe overall prevalence of POSAMINO in the study population was 28%, with 10% at risk of at least one POSAMINO criteria and 18% at risk of two or more. Exposure to POSAMINO most commonly involved cardiovascular agents (19%) and central nervous system agents (15%). Exposure to a higher number of POSAMINO criteria was associated with younger age (adjusted incident rate ratio (AIRR): 0.97; 95% CI: 0.95 to 0.98), male sex (AIRR: 0.55; 95% CI: 0.45 to 0.67) and a higher number of comorbidities (AIRR: 1.05; 95% CI: 1.01 to 1.13).ConclusionThis study adds to the growing body of evidence, which suggests that older adults are vulnerable to potentially serious alcohol–medication interactions, particularly those involving cardiovascular and central nervous system agents, increasing their risk of orthostatic hypotension, gastrointestinal bleeds and increased sedation. Application of the POSAMINO criteria at the point of prescribing may facilitate the risk stratification of older adults and prioritise alcohol screening and brief alcohol interventions in those at greatest risk of harm.

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“…However, clinical trials often exclude the frailest among the older population, who are at particular risk for falls and fractures. While chronic use of antihypertensives was not associated with falls in older people (OR 0.97 [0.93–1.01]) [ 25 ], several studies reported increased risk for falls [ 26 ] and injurious falls [ 4 , 5 ] when initiating or re-starting antihypertensives in long-term users after short treatment breaks [ 29 ]: Gribbin and colleagues [ 26 ] assessed the risk for a first fall in the 21 days following antihypertensive treatment initiation using SCCS in older UK patients. Increased fall risk was reported for thiazide diuretics (IRR 1.63 [1.20–2.20]), but not for other antihypertensive drug classes.…”

Section: Discussionmentioning

confidence: 99%

Risk of adverse events following the initiation of antihypertensives in older people with complex health needs: a self-controlled case series in the United Kingdom

Jödicke,

Tan,

Robinson

et al. 2023

Age and Ageing

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Background We assessed the risk of adverse events—severe acute kidney injury (AKI), falls and fractures—associated with use of antihypertensives in older patients with complex health needs (CHN). Setting UK primary care linked to inpatient and mortality records. Methods The source population comprised patients aged >65, with ≥1 year of registration and unexposed to antihypertensives in the year before study start. We identified three cohorts of patients with CHN, namely, unplanned hospitalisations, frailty (electronic frailty index deficit count ≥3) and polypharmacy (prescription of ≥10 medicines). Patients in any of these cohorts were included in the CHN cohort. We conducted self-controlled case series for each cohort and outcome (AKI, falls, fractures). Incidence rate ratios (IRRs) were estimated by dividing event rates (i) during overall antihypertensive exposed patient-time over unexposed patient-time; and (ii) in the first 30 days after treatment initiation over unexposed patient-time. Results Among 42,483 patients in the CHN cohort, 7,240, 5,164 and 450 individuals had falls, fractures or AKI, respectively. We observed an increased risk for AKI associated with exposure to antihypertensives across all cohorts (CHN: IRR 2.36 [95% CI: 1.68–3.31]). In the 30 days post-antihypertensive treatment initiation, a 35–50% increased risk for falls was found across all cohorts and increased fracture risk in the frailty cohort (IRR 1.38 [1.03–1.84]). No increased risk for falls/fractures was associated with continuation of antihypertensive treatment or overall use. Conclusion Treatment with antihypertensives in older patients was associated with increased risk of AKI and transiently elevated risk of falls in the 30 days after starting antihypertensive therapy.

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Association between gaps in antihypertensive medication adherence and injurious falls in older community-dwelling adults: a prospective cohort study

Cited by 13 publications

References 55 publications

Antihypertensive Medication Adherence and the Risk of Vascular Events and Falls After Stroke: A Real-World Effectiveness Study Using Linked Registry Data

Antihypertensive Medication Adherence and the Risk of Vascular Events and Falls After Stroke: A Real-World Effectiveness Study Using Linked Registry Data

Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

Risk of adverse events following the initiation of antihypertensives in older people with complex health needs: a self-controlled case series in the United Kingdom

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