High blood pressure is one of the most common health problems in older adults.
If it is left untreated, it can greatly increase the risk of heart attacks, strokes, heart failure, kidney disease, and other serious medical conditions.
Because of these dangers, doctors often prescribe blood pressure medicines to lower blood pressure and protect long-term health. For many people, these medicines save lives.
However, treating high blood pressure in very old adults can sometimes be challenging. Many nursing home residents are frail, have several medical conditions, take many medicines at the same time, or have problems with balance and memory. In these people, blood pressure medicines may also increase the risk of side effects, especially soon after treatment begins.
A new study led by Dr. Chintan V. Dave at Rutgers University has found that starting blood pressure medication may increase the risk of falls, broken bones, and fainting among older adults living in nursing homes. The research was published in the journal JAMA Internal Medicine.
The researchers examined medical records from nearly 30,000 veterans receiving long-term care through the Veterans Health Administration in the United States. Because it would be difficult and expensive to conduct a large clinical trial in this population, the scientists used an advanced research method known as target trial emulation.
This approach uses real-world health records to closely imitate the design of a randomized clinical trial, allowing researchers to estimate what might happen if patients started or did not start a treatment.
The results showed a clear increase in injuries among people who began taking blood pressure medicines. Among residents who started treatment, the fracture rate was 5.4 cases per 100 person-years.
In comparison, residents who did not begin treatment had a fracture rate of only 2.2 cases per 100 person-years. In other words, the risk of breaking a bone was more than twice as high after starting medication.
The study also found that serious falls became much more common. These were falls severe enough to require treatment in an emergency department or admission to a hospital. In addition, the chance of fainting increased by around 70 percent after treatment began.
Some residents appeared to face even greater risks. People living with dementia, those whose blood pressure remained above 140/80 mmHg before treatment, and people who had not recently been taking blood pressure medicines experienced the highest fracture risk.
In some of these groups, the likelihood of fractures was nearly five times greater than in lower-risk residents.
Why might this happen? Blood pressure medicines lower blood pressure, but when treatment first begins, blood pressure may sometimes fall too much, especially when a person stands up quickly.
This condition, known as orthostatic hypotension, can cause dizziness, lightheadedness, blurred vision, or fainting. For older adults with poor balance or weak muscles, even a brief episode of dizziness can lead to a serious fall.
The findings do not mean that people should stop taking their blood pressure medicines. High blood pressure remains a major risk factor for heart attacks and strokes, and treatment continues to provide important health benefits for many older adults. Instead, the study highlights the importance of choosing treatment carefully for frail nursing home residents.
The researchers suggest that doctors should consider each person’s overall health rather than relying only on blood pressure numbers. Factors such as dementia, previous falls, balance problems, frailty, kidney function, and the number of medicines a person already takes should all be considered before starting treatment.
In many cases, doctors may reduce the risk by following the principle of “start low and go slow.” This means beginning with a low dose of medicine, increasing it gradually if needed, and monitoring patients closely during the first few weeks.
Blood pressure should be checked both while sitting and standing, and any symptoms such as dizziness or fainting should be reported immediately.
Healthy lifestyle habits also remain an important part of blood pressure management. Eating a balanced diet, reducing salt intake, staying physically active when possible, maintaining a healthy weight, and avoiding smoking can all help support healthy blood pressure alongside medical treatment.
Overall, this study reminds us that every treatment has both benefits and risks. For frail older adults living in nursing homes, careful, personalized care may help reduce injuries while still protecting against the long-term dangers of high blood pressure.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and natural coconut sugar could help reduce blood pressure and artery stiffness.
For more health information, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing vitamin D could improve blood pressure in people with diabetes.
The research was published in JAMA Internal Medicine.
