The risk of falls on initiation of antihypertensive drugs in the elderly

Butt, Debra A.; Mamdani, Muhammad; Austin, Peter C.; Tu, Karen; Gomes, Tara; Glazier, Richard H.

doi:10.1007/s00198-013-2369-7

Cited by 117 publications

(119 citation statements)

References 38 publications

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“…There are some published studies on the immediate risk of falls and fractures in hypertensive elderly during the initiation of antihypertensive medications, and these studies are summarized in Table 1. The majority of studies in Table 1 involved communitydwelling elderly [27][28][29][30][31], while only one study had hospitalized patients [32]. These studies indicate that elderly hypertensive patients who start an antihypertensive drug for the treatment of hypertension may have an increased risk of falls or fracture during drug initiation.…”

Section: Antihypertensive Drug Initiation and Fracture Riskmentioning

confidence: 95%

“…These studies indicate that elderly hypertensive patients who start an antihypertensive drug for the treatment of hypertension may have an increased risk of falls or fracture during drug initiation. Falls usually precede fracture injuries, and elderly patients who start an antihypertensive drug may have a 69 % increased risk of having an injurious fall during the first 45 days of antihypertensive drug treatment (incidence rate ratio, IRR 1.69, 95 % CI 1.57-1.81) which is more pronounced during the first 14 days of antihypertensive drug use (IRR 1.94, 95 % CI 1.75-2.16) [27]. This finding was consistent for each of the antihypertensive drug classes [27].…”

Section: Antihypertensive Drug Initiation and Fracture Riskmentioning

confidence: 98%

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Hypertension, Antihypertensive Drugs and the Risk of Fractures

Butt

Alharty

Leu

et al. 2015

Clinic Rev Bone Miner Metab

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Older adults have a higher prevalence of hypertension, and specifically systolic hypertension, than any other age group in the general population as the likelihood of developing hypertension during an average lifespan is high. Osteoporosis like hypertension is a chronic medical condition that can predispose the elderly to increased fracture risk. The relationship between hypertension, antihypertensive medications and osteoporosisrelated fractures is complex as hypertension and the medications used to treat hypertension such as thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers and beta-adrenergic blockers may have differential effects on bone. The purpose of this review is to provide an overview of the relationship between hypertension and bone and to examine the association between different antihypertensive medications on fracture risk in the elderly.

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Section: Antihypertensive Drug Initiation and Fracture Riskmentioning

confidence: 95%

Section: Antihypertensive Drug Initiation and Fracture Riskmentioning

confidence: 98%

Hypertension, Antihypertensive Drugs and the Risk of Fractures

Butt

Alharty

Leu

et al. 2015

Clinic Rev Bone Miner Metab

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“…Риск падений существенно повышается в первые недели после начала лечения [43,44]. В то же время есть данные о снижении риска падений у пожилых под влиянием ингибиторов АПФ и БКК, причем более высокие дозы этих препаратов ассоциировались с большим снижением риска падений [45].…”

Section: Pharmacotherapy Of Hypertension In the Elderly фармакотерапиunclassified

Pharmacotherapy of Arterial Hypertension in Elderly Patients: Focus on Octogenarians

Ушкалова

Ткачева²,

Рунихина³

et al. 2016

Racionalʹnaâ farmakoterapiâ v kardiologii

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Артериальная гипертензия (АГ) ежегодно является причиной более 7 млн. преждевременных смертей и занимает 4,5% в глобальной структуре бремени за-болевания (преждевременная смерть+инвалидиза-ция) [1]. Распространенность АГ повышается с возрас-том -по данным исследования National Health and Nutrition Examination Survey она составляет у мужчин в воз-расте 45-54 лет 36,8%, у женщин -32,7%, старше 75 лет -76,4 и 79,9%, соответственно [2]. В связи с по-старением населения и ростом распространенности АГ прогнозируется, что к 2030 г. осложнения заболевания станут причиной четверти всех смертей в мире [3]. При этом фармакотерапия больных старшего возраста ос-новывается преимущественно на консенсусных, а не до-казательных данных, так как эти пациенты обычно не включаются в рандомизированные клинические ис-следования (РКИ). Особенности артериальной гипертензии и ее фармакотерапии у пожилых пациентовЛечение больных пожилого возраста осложняется целым рядом взаимосвязанных проблем, представ-ленных на рис. 1.К числу основных особенностей АГ у лиц пожило-го возраста относится превалирование изолированной систолической артериальной гипертонии (ИСАГ), ас-социирующейся с высоким риском развития сердечно-сосудистых осложнений. Ее доля среди лиц в возрас-те >60 лет составляет 65%, а >70 лет -90% [5]. По дан-ным мета-анализа, повышение систолического арте-риального давления (САД) на каждые 20 мм рт.ст. ас-социируется с удвоением смертности от ишемической болезни сердца и инсульта, причем абсолютный риск кардиоваскулярной смертности при равном повыше-нии САД у пожилых пациентов достоверно превыша-ет таковой у лиц моложе 50 лет [6] Pharmacotherapy of arterial hypertension in the elderly is discussed. Russian and international guidelines are presented with a focus on target levels of blood pressure and drugs of choice in these patients. Issues of efficacy and safety of antihypertensive therapy in patients aged 80 years and older are considered.

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“…New users had a 69% increased risk of having an injurious fall during the first 45 days following antihypertensive treatment (95% CI, 1.57-1.81). 56 Medication reconciliation is vital in preventing adverse events in care transition (eg, on admission, at discharge), where medication changes usually occur among patients with polypharmacy; therefore, it is worth conducting further study to investigate whether medication reconciliation would decrease the risk of falling in the elderly.…”

Section: Medication Changementioning

confidence: 99%

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

Zhou¹,

Chen²,

Zhu³

2014

OTT

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Background: Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an upto-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods: Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results: Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer's agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug-drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion: Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient's medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could ...

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The risk of falls on initiation of antihypertensive drugs in the elderly

Abstract: This study suggests that initiation of antihypertensive drugs is a risk factor for falls in the elderly. Fall prevention strategies during this period may reduce injuries.

Cited by 117 publications

References 38 publications

Hypertension, Antihypertensive Drugs and the Risk of Fractures

Hypertension, Antihypertensive Drugs and the Risk of Fractures

Pharmacotherapy of Arterial Hypertension in Elderly Patients: Focus on Octogenarians

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

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