Osteoporosis International

, Volume 24, Issue 10, pp 2649–2657 | Cite as

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

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



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.


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


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.


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.


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.


Antihypertensive drugs Elderly Falls Self-controlled case series 



We thank Dr. Paddy Farrington (PhD, Division of Statistics, Open University, Milton Keynes, England) for his contribution to the study design and analytical assistance. This work was funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The sponsor did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review or approval of the manuscript. The opinions, results, and conclusions are those of the authors and no endorsement by the MOHLTC or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. Dr. Austin was supported by a Career Investigator Award from the Heart and Stroke Foundation of Ontario. Dr. Tu was supported by a Canadian Institutes of Health Research Fellowship Award in Primary Care.

Conflicts of interest

Dr. Butt, Dr. Glazier, Dr. Austin, Dr. Tu, and Tara Gomes declare no conflict of interest. Dr. Mamdani reported that he is a consultant for Hoffman LaRoche, Glaxo-Smith Kline, Pfizer, Novartis, and Lilly.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • D. A. Butt
    • 1
    • 2
    Email author
  • 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

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