Friday, February 28, 2014

BP Meds Linked to Serious Fall Injuries in Elderly

Taking antihypertensive medications may lead to a significantly increased risk for serious fall injuries among older adults with hypertension and multiple comorbidities, according to an articlepublished online February 24 in JAMA Internal Medicine. The risk may be doubled for those individuals who have had a previous fall in the past year.

He continued, "For patients, it's not so simple. Most patients are on 10-plus medicines by the time they're 70, and it's been absolutely, unequivocally shown that when you're on 10-plus meds, the side effects start to creep up. If you fall, your morbidity goes skyrocketing. So anything you gain with blood pressure lowering starts to become eroded with what you lose with the blood pressure falling."

"What this article really brings forward, and it's not unique, is that the benefit of decreased cardiovascular events is completely integrated with the greater risk of falls," Daniel E. Forman, MD, chair of the American College of Cardiology Geriatric Cardiology Section, director of the exercise testing laboratory and cardiac rehabilitation at Brigham and Women's Hospital, and associate professor of medicine at Harvard Medical School in Boston, told Medscape Medical News in a telephone interview.

In an accompanying invited commentary, Sarah D. Berry, MD, MPH, and Douglas P. Kiel, MD, MPH, from the Institute for Aging Research, Hebrew Rehabilitation Center, Boston, Massachusetts, write that balancing potential harms and benefits should be done according to individual patients.

"For some patients, concern about injurious falls may be paramount, whereas other patients fear the complications of untreated hypertension," the commentators write. "Unfortunately, there is no easy way for clinicians to compare these risks; thus, a candid discussion with each patient is advisable."

Complicated Conversations

Dr. Forman said the aging population in the United States mandates that physicians get better at stratifying patients and identifying which would benefit from antihypertensives and which would not. Complicating the issue is the lack of clear data on older adults and the practice of extrapolating from data on younger patients. Other complications include the time spent with patients and the complexities of aging.

He asked, "In 15 minutes, given all the complexities of language, cognition, and multimorbidity — and you're dealing with 10 things at once with your patient to begin with — how do you have this very sophisticated conversation with them and try to work out these details and really make life-prolonging, definitive decisions about health management in that short time period?"

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