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Antihypertensive Medications, Loop Diuretics, and Risk of Hip Fracture in the Elderly: A Population-Based Cohort Study of 81,617 Italian Patients Newly Treated Between 2005 and 2009

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Abstract

Objective

Our objective was to assess the relationship between antihypertensive drugs, loop diuretics, and the risk of hospitalization for hip fracture (HF).

Design

We conducted a population-based study in a cohort of 81,617 patients from Lombardy (Italy) aged 70–90 years who were newly treated with antihypertensive agents or loop diuretics between 2005 and 2009. Cases were the 2153 patients who experienced the outcome (hospitalization for HF before 31 December 2012). For each case, up to three controls were randomly selected from the cohort to be matched for sex, age at cohort entry, and date of initial prescription. The case–control and case-crossover designs and the logistic regression for matched sets were used to measure the strength of the association between current use of an antihypertensive drug (within 30 days before the HF hospitalization) and the risk of outcome.

Results

Case–control and case-crossover odds ratios (ORs) for current use of loop diuretics were 1.67 (95 % confidence interval [CI] 1.28–2.18) and 1.49 (95 % CI 1.05–2.10), respectively. Among patients aged 81–90 years, case–control and case-crossover ORs were 1.52 (95 % CI 1.04–2.21) and 1.82 (95 % CI 1.10–3.00) for current use of loop diuretics and 1.86 (95 % CI 1.03–3.35) and 1.88 (95 % CI 1.01–3.48) for α-blockers. No other agent was associated with the outcome.

Conclusions

Evidence that loop diuretics and α-blockers are associated with a higher risk of HF was consistent in the two observational approaches. Clinicians should carefully consider the risk of falls in their selection of drugs for hypertension and in the clinical use of loop diuretics.

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Authors and Affiliations

  1. Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy

    Giovanni Corrao, Matteo Monzio Compagnoni & Federico Rea

  2. Department of Health Sciences, University of Milano-Bicocca, Milan, Italy

    Paolo Mazzola, Giorgio Annoni & Giuseppe Mancia

  3. Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy

    Luca Merlino

  4. Geriatric Clinic, San Gerardo University Hospital, Monza, Italy

    Giorgio Annoni

  5. Istituto Auxologico Italiano, Milan, Italy

    Giuseppe Mancia

Authors
  1. Giovanni Corrao
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  2. Paolo Mazzola
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  3. Matteo Monzio Compagnoni
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  4. Federico Rea
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  5. Luca Merlino
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  7. Giuseppe Mancia
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Corresponding author

Correspondence to Giovanni Corrao.

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Funding

Support for this study come from the Italian Ministry of Education, University and Research grants (“Fondo d’Ateneo per la Ricerca” portion, year 2014).

Disclosures

GC has received research support from the European Community (EC), the Italian Agency of Drugs (AIFA), and the Italian Ministry for University and Research (MIUR). He has taken part in a variety of projects funded by pharmaceutical companies (i.e., Novartis and GSK). He has also received honoraria as member of Advisory Board from Roche.

GM has received honoraria for participation as speaker/chairman in national/international meetings from Bayer, Boehringer Ingelheim, CVRx, Daiichi Sankyo, Ferrer, Medtronic, Menarini Int., Merck, Novartis, Recordati, and Servier.

PM, MMC, FR, LM, and GA declare that they have no conflicts of interest.

Research involving human participants and/or animals

The present research did not involve any trials on human participants or animals.

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Corrao, G., Mazzola, P., Monzio Compagnoni, M. et al. Antihypertensive Medications, Loop Diuretics, and Risk of Hip Fracture in the Elderly: A Population-Based Cohort Study of 81,617 Italian Patients Newly Treated Between 2005 and 2009. Drugs Aging 32, 927–936 (2015). https://doi.org/10.1007/s40266-015-0306-5

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  • DOI: https://doi.org/10.1007/s40266-015-0306-5

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