Osteoporosis International

, Volume 24, Issue 10, pp 2649–2657

The risk of falls on initiation of antihypertensive drugs in the elderly

  • D. A. Butt
  • M. Mamdani
  • P. C. Austin
  • K. Tu
  • T. Gomes
  • R. H. Glazier
Original Article

DOI: 10.1007/s00198-013-2369-7

Cite this article as:
Butt, D.A., Mamdani, M., Austin, P.C. et al. Osteoporos Int (2013) 24: 2649. doi:10.1007/s00198-013-2369-7

Abstract

Summary

Antihypertensive drugs are associated with an immediate increased falls risk in elderly patients which was significant during the first 14 days after receiving a thiazide diuretic, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker, or beta-adrenergic blocker. Fall prevention strategies during this period may prevent fall-related injuries.

Introduction

The purpose of this study is to evaluate if initiation of the common antihypertensive drugs is associated with the occurrence of falls.

Methods

This population-based self-controlled case series study used healthcare administrative databases to identify new users of antihypertensive drugs in the elderly aged 66 and older living in Ontario, Canada who suffered a fall from April 1, 2000 to March 31, 2009. The risk period was the first 45 days following antihypertensive therapy initiation, further subdivided into 0–14 and 15–44 days with control periods before and after treatment in a 450-day observation period. We calculated the relative incidence (incidence rate ratio, IRR), defined as the rate of falls in the risk period compared to falls rate in the control periods.

Results

Of the 543,572 new users of antihypertensive drugs among community-dwelling elderly, 8,893 experienced an injurious fall that required hospital care during the observation period. New users had a 69 % increased risk of having an injurious fall during the first 45 days following antihypertensive treatment (IRR = 1.69; 95 % CI, 1.57–1.81). This finding was consistent for thiazide diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers but not angiotensin II receptor antagonists. There was also an increased falls risk during the first 14 days of antihypertensive drug initiation (IRR = 1.94; 95 % CI, 1.75–2.16), which was consistent for all antihypertensive drug classes.

Conclusions

This study suggests that initiation of antihypertensive drugs is a risk factor for falls in the elderly. Fall prevention strategies during this period may reduce injuries.

Keywords

Antihypertensive drugsElderlyFallsSelf-controlled case series

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • D. A. Butt
    • 1
    • 2
  • M. Mamdani
    • 3
  • P. C. Austin
    • 4
  • K. Tu
    • 4
    • 5
  • T. Gomes
    • 4
  • R. H. Glazier
    • 4
    • 6
  1. 1.Department of Family and Community Medicine, The Scarborough HospitalUniversity of TorontoTorontoCanada
  2. 2.Ellesmere Health Care CentreScarboroughCanada
  3. 3.Applied Health Research CentreLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  4. 4.Institute for Clinical Evaluative SciencesTorontoCanada
  5. 5.Department of Family and Community Medicine, Toronto Western Hospital Family Health TeamUniversity of TorontoTorontoCanada
  6. 6.Department of Family and Community Medicine, St. Michael’s Hospital, University of TorontoTorontoCanada