Antihypertensive medications are frequently prescribed to the elderly. However, the association between these medications and the risk of fractures has only been minimally reported until the recent findings of a retrospective study. This study, conducted by Dave et al., analysed data from 64,710 older long-term care nursing home residents (mean age [SD]= 77.9[8.5] years). By using the propensity score matching approach, they reported that the incidence rate of fractures per 100 person-years in residents initiating antihypertensive medication (n=12,942) was 5.4 compared with 2.2 in the control arm (n=51,768), during a mean (SD) follow-up of 18.2 (8.7) days for the antihypertensive group and 16.8 (8.7) days for the control group. The findings corresponded to an adjusted hazard ratio (HR) of 2.42 (95% [confidence interval] CI, 1.43-4.08) cases of fractures per 100 person-years and an adjusted excess risk per 100 person-years of 3.12 (95% CI, 0.95-6.78). In addition, antihypertensive medication initiation and syncope are two factors associated with higher risk of severe falls requiring hospitalisation with a HR of 1.8 (05% CI, 1.53-2.13) and 1.69 (95% CI, 1.3-2.19) respectively. Besides, the magnitude of fracture risk was numerically higher among subgroups of residents with dementia (HR= 3.28, [95% CI, 1.76-6.1]), systolic blood pressure of 140 mm Hg or higher (HR= 4.41 [95% CI, 1.67-11.68]). It is recommended that additional monitoring should be implemented when initiating antihypertensive medication for individuals belonging to those vulnerable populations.

Reference

 20. Dave CV, et al. JAMA Intern Med. Published online April 22, 2024. doi:10.1001/jamainternmed.2024.0507