Citation

Shimbo D, Barrett Bowling C, Levitan EB, Deng L, Sim JJ, Huang L, Reynolds K, Muntner P. Circ. Cardiovasc. Qual. Outcomes 2016; 9(3): 222-229.

Affiliation

From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1161/CIRCOUTCOMES.115.002524

PMID

27166208

Abstract

BACKGROUND: Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls after antihypertensive medication initiation and intensification.

METHODS AND RESULTS: We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90 127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007, and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the previous year. Intensification was defined by the addition of a new antihypertensive class, and separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days after antihypertensive medication initiation (odds ratio, 1.36 [95% confidence interval, 1.19-1.55]), adding a new class (odds ratio, 1.16 [95% confidence interval, 1.10-1.23]), and titration [odds ratio, 1.13 [95% confidence interval, 1.08-1.18]). These associations were attenuated beyond 15 days.

CONCLUSIONS: Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults.

© 2016 American Heart Association, Inc.

Language: en