A new study published in JAMA Internal Medicine has revealed a troubling connection between starting blood pressure medications and an increased risk of falls, fractures, and fainting among elderly residents in nursing homes.
This research was led by Dr. Chintan V. Dave and his team from Rutgers University and focused on a large group of veterans living in long-term care facilities.
The study looked at data from nearly 30,000 older veterans in the Veterans Health Administration system.
Using a method called “target trial emulation,” the researchers tried to recreate the conditions of a clinical trial using real-world patient data.
This approach allowed them to closely examine the effects of starting antihypertensive (blood pressure-lowering) medications on this vulnerable population.
The findings are significant and raise serious concerns. Among the residents who began taking antihypertensive medications, the rate of fractures was 5.4 per 100 person-years. In contrast, those who didn’t start the medications had a much lower rate of 2.2 fractures per 100 person-years.
This means the people on the medication had more than double the risk of fractures, with an adjusted hazard ratio of 2.42 and an excess risk of 3.12 fractures per 100 person-years.
But the risks didn’t stop there. The study also found higher rates of serious falls—those requiring emergency treatment or hospital stays—and more cases of syncope (fainting) among those who began blood pressure treatment. The risk of severe falls was nearly doubled (hazard ratio of 1.80), and the risk of fainting increased by about 70% (hazard ratio of 1.69).
The study also identified certain groups who were at especially high risk. Residents with dementia, those with higher blood pressure (systolic 140 mm Hg or above and diastolic 80 mm Hg or above), and those who had not recently used antihypertensive drugs were even more likely to suffer fractures. For these individuals, the risk was up to nearly five times higher than average, with hazard ratios ranging from 3.28 to 4.77.
These results highlight the need for extra caution when prescribing blood pressure medications to older adults in nursing homes. While controlling high blood pressure is important for preventing heart attacks and strokes, this study shows that the benefits must be carefully balanced against the risks—especially during the first weeks after starting a new medication.
Doctors and caregivers are encouraged to take a more personalized approach, considering the individual’s overall health, risk of falling, and other conditions like dementia. Regular monitoring, slow dose adjustments, and non-drug strategies for managing blood pressure may be safer for some residents.
This study is a powerful reminder that medications—especially in the elderly—can have serious side effects. It adds to growing research urging healthcare providers to “start low and go slow” when it comes to treating high blood pressure in older adults.
For more insights into high blood pressure management, including the role of diet and nutrients like potassium, or how certain foods such as potatoes might affect blood pressure, readers are encouraged to explore recent studies and trusted health sources.
The full findings of this important study can be found in JAMA Internal Medicine.
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