Changes in Blood Pressure Treatment Associated With Falls in Elderly

Changes during the treatment of blood pressure with medications may cause falls in elderly due to postural hypotension, resulting in serious injury.

Falls are a common cause of disability and death in the elderly.
Postural hypotension is a common cause of falls in the elderly.
Changes in blood pressure medications during treatment for hypertension may increase the risk of falls in the elderly.

A recent study finds that elderly hypertensive patients are at an increased risk of fall immediately following the initiation or modification of treatment.

Falls are a common cause of injury and disability in people of the older age group, often making them dependent on caregivers. Their weak osteoporotic bones crack easily, sometimes even with minor injury. A fall may reduce their confidence and keep them confined to their homes even if they are not injured.

Postural and Postprandial Hypotension
A recent article described details of two types of hypotension, postprandial and postural. A brief summary is presented below.

‘Hypertensive patients should be monitored for 2 weeks following treatment changes to prevent falls.’

Older people often experience problems with balance which makes them prone to falls. One common cause is decreased vision due to which they may bump into an obstruction or miss a step. Some suffer dizziness due to abnormal heart rhythms. The side effects of their numerous medications only make things worse.

Another important cause for falls is postural hypotension; wherein the blood pressure falls while suddenly moving from the lying to an erect posture. Postural hypotension is a common side effect caused by several blood pressure medications. Antihypertensive drugs can also cause other problems like dizziness, balance problems and low sodium levels, which could increase the chance of dizziness especially in the elderly.

A study published in Circulation: Cardiovascular Quality and Outcomes evaluated the risk of falls causing serious injury during initiation or changes in the treatment of hypertension. The data were obtained from Medicare claims put forth by beneficiaries over a five-year period between July 2007 and December 2012.

Guidelines for the Elderly that can Protect Against Falls
Taking a fall in older life can not only result in injury, but also a potentially debilitating loss of confidence.

The researchers identified 90,127 patients who had serious injuries due to falls like brain injury, dislocation of the hip, knee, or jaw, and fractures of the facial bones, pelvis, and hip. These injuries had a potential to severely disable the patient. Some of the injuries were even fatal.

The researchers found that risk of a fall resulting in a serious injury was increased following either of the following situations:

Starting treatment with a new antihypertensive medication: In the 272 patients who were started on a new antihypertensive drug, the risk of fall increased by 36%.
Adding a new class of antihypertensive drug to the existing treatment: A new class of antihypertensive drug was added to 1508 patients, who had a 16% increased risk of fall.
Titrating the dosage of antihypertensive medication for better control of blood pressure: The dosage was titrated in 3113 patients, in whom the risk of fall was increased by 13%.

The increased risk of fall was noted for two weeks following the change in treatment and did not last beyond 15 days.

Simple Exercises can Prevent Falls in Elderly
Strength training and balance can reduce falls in older adults, reports study.

It is also possible that many more people suffered from falls due to change in medications, but did not report since it did not cause any injury.

This study signifies the importance of taking extra precautions against falls and monitoring the patient following medication change or dosage increases of antihypertensive medications, at least in the initial 15 days.

Fluid and Electrolyte Abnormalities Common in Elderly
Elderly people are commonly susceptible to fluid and electrolyte balance due to age-related changes, diseases and medications.

References:

Shimbo D, Bowling CB, Levitan EB, Deng L, Sim JJ, Huang L, Reynolds K, Muntner P. Short-Term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment With Antihypertensive Medication. CIRCOUTCOMES.115.002524

Source-Medindia