TY  - JOUR
PY  - 2024//
TI  - Blood pressure management and falls in nursing home residents-a matter of balance
JO  - JAMA internal medicine
A1  - Canales, Muna Thalji
A1  - Shorr, Ronald I.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - In this study, Dave et al1 harness national Veterans Health Administration (VHA) clinical data to examine the association between initiation of a new antihypertensive agent with the incidence of fall-related fractures in residents at VHA nursing homes, or community living centers. In this carefully designed study, residents who received a new antihypertensive agent had more than 2-fold greater risk of fractures compared with those who did not (adjusted hazard ratio [aHR], 2.42 [95% CI, 1.43-4.08]). This practice was also associated with 1.8-fold greater risk of serious falls (HR, 1.80 [95% CI, 1.52-2.13]) and 1.7-fold greater risk of syncope (HR, 1.69 [95% CI, 1.30-2.19]). Subgroup analysis revealed an even higher risk of fractures in nursing home residents with dementia (HR, 3.28 [95% CI, 1.76-6.10]), elevated systolic (HR, 3.12 [95% CI, 1.71-5.69]) or diastolic (HR, 4.41 [95% CI, 1.67-11.68]) blood pressure, and those who had not used antihypertensives (HR, 4.77 [95% CI, 1.49-15.32]). These findings create a compelling narrative that rapidly decreasing blood pressure in nursing home residents may cause orthostatic hypotension, leading to falls and fractures. They also extend the findings from a smaller study of participants in the Systolic Blood Pressure Intervention Trial (SPRINT).2 In a secondary analysis of SPRINT, participants randomized to intensive treatment of systolic hypertension (blood pressure <120 mm Hg) were more likely to experience hypotension, and possibly syncope, but not falls...<p />  <p>Language: en</p>
LA  - en
SN  - 2168-6106
UR  - http://dx.doi.org/10.1001/jamainternmed.2024.0506
ID  - ref1
ER  -