For Older Women, Taking High Blood Pressure Medication May Not Raise Risk for Falls

Journal of the American Geriatrics Society Research Summary

High blood pressure (also known as hypertension) is the medical term for when the force of blood against your blood vessel walls is too high. We know that using medication to lower high blood pressure can prevent heart attacks and strokes. But healthcare professionals often worry that prescriptions for lowering high blood pressure can sometimes lower it too much. This can put you at risk for becoming dizzy and falling.

Falls are a serious problem in older adults. In 2014, falls caused 2.8 million emergency room visits, 800,000 hospitalizations, and 27,000 deaths, and cost Medicare an estimated $31.3 billion.

Although some healthcare experts suspect that taking high blood pressure medication over time is linked to falls and fractures, very little research supports that belief. In fact, at least two major studies examining blood pressure reduction did not find an increased risk for falls among people taking medication to reduce high blood pressure. Other studies have not shown an increase in fracture risk for people taking medication for high blood pressure—in fact, some studies suggest that high blood pressure medicines may actually reduce the risk for fractures.

Researchers decided to learn more about the links between falls, high blood pressure, and high blood pressure medication in older women. They published their study in the Journal of the American Geriatrics Society.

The research team used information from the Women’s Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health (OPACH) study. This study was designed to examine the risk of falls for older women (aged 50 to 79) based on their high blood pressure status.  (High blood pressure is often defined as having a reading of 140 mmHg for your “systolic” blood pressure and 90 mmHg or higher for your “diastolic” blood pressure).

Among women with high blood pressure, the researchers looked at participants who did or did not take medication to control their condition. They also took note of the participants’ blood pressure readings over the course of the study.

5,971 women in the study received home visits. Most of the women were in their late 70s. During the visits, the participants had their blood pressure tested. They also were tested to measure their balance, walking speed, and their ability to stand from a seated position. The women also kept calendars for 13 months showing whether or not they had experienced a fall, or if they had come close to falling.

The researchers concluded there was no increased risk of falls among women who took high blood pressure medication compared to those whose blood pressure readings were normal.

In fact, women whose blood pressure was normal with medication had a 15 to 20 percent lower risk of falls compared to women who didn’t have high blood pressure.

The researchers also concluded that taking medication to reduce high blood pressure was not linked to falls in older women. However, other researchers looking at studies with large numbers of participants have found that the risk of falls increased in the first several weeks after people began taking medication to reduce high blood pressure. The increased risk disappeared after the first several weeks.

The researchers suggested that healthcare practitioners measure blood pressure carefully in the office, and potentially have blood pressure measurements taken at home to confirm whether older women need to take medication to lower high blood pressure.

While the risk of a serious fall injury is low for women taking medication for high blood pressure, the researchers suggested that it makes sense to monitor patients for the first few weeks after starting a new medication to reduce high blood pressure—or after raising the dosage for a medication they’re already taking. The researchers said that for women who are doing well and tolerating a new prescription after the first several weeks, it seems likely that they can enjoy the long-term health benefits of better blood pressure control without an increased risk for falls.

 This summary is from “Hypertension Treatment & Falls in Older Women.” It appears online ahead of print in the December 2018 issue of the Journal of the American Geriatrics Society. The study authors are Karen L. Margolis, MD, MPH; David M. Buchner, MD, MPH; Michael J. LaMonte, PhD, MPH; Yuzheng Zhang, MS; Chongzhi Di, PhD; Eileen Rillamas-Sun, PhD, MPH; Julie Hunt, PhD; Farha Ikramuddin; Wenjun Li; Steve Marshall, PhD; Dori Rosenberg, PhD, MPH; Marcia L. Stefanick, PhD; Robert Wallace; and Andrea Z. LaCroix, PhD.

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