Blood pressure drugs linked to bone fractures in older people

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A new study published in JAMA Internal Medicine has highlighted a concerning association between the initiation of antihypertensive medication and an increased risk of falls and fractures among long-term nursing home residents.

This research, conducted by Chintan V. Dave, Pharm.D., Ph.D., and his team at Rutgers University, involved a retrospective cohort study of 29,648 older veterans residing in long-term care facilities within the Veterans Health Administration.

The study utilized a method known as target trial emulation to analyze the data, aiming to mimic the conditions of a randomized controlled trial.

The findings are significant: the incidence rate of fractures per 100 person-years was 5.4 among residents who started antihypertensive medication, compared to just 2.2 in those who did not begin such treatment.

This difference corresponds to an adjusted hazard ratio of 2.42, indicating more than double the risk, and an adjusted excess risk of 3.12 per 100 person-years.

Moreover, the initiation of antihypertensive medication was also associated with a heightened risk of severe falls that required hospitalization or emergency department visits, as well as an increased incidence of syncope (fainting), with hazard ratios of 1.80 and 1.69, respectively.

Particularly noteworthy is the increased fracture risk observed in specific subgroups of nursing home residents.

Those with dementia, higher systolic blood pressure (140 mm Hg or above), higher diastolic blood pressure (80 mm Hg or above), and those who had not recently used antihypertensive medications faced even greater risks.

Hazard ratios in these groups ranged from 3.28 to 4.77, suggesting a markedly higher vulnerability.

These findings underscore the necessity of cautious consideration when initiating antihypertensive treatments in elderly nursing home residents, particularly during the high-risk period following the start of medication.

This study serves as an important reminder for healthcare providers to weigh the benefits and risks of antihypertensive therapies and to monitor closely for potential adverse effects such as falls and fractures, which can significantly impact the health and quality of life of these individuals.

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The research findings can be found in AMA Internal Medicine.

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