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Low blood pressure levels for fall injuries in older adults: the Health, Aging and Body Composition Study

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Abstract

Fall injuries cause morbidity and mortality in older adults. We assessed if low blood pressure (BP) is associated with fall injuries, including sensitivity analyses stratified by antihypertensive medications, in community-dwelling adults from the Health, Aging and Body Composition Study (N = 1819; age 76.6 ± 2.9 years; 53% women; 37% black). Incident fall injuries (N = 570 in 3.8 ± 2.4 years) were the first Medicare claims event from clinic visit (7/00–6/01) to 12/31/08 with an ICD-9 fall code and non-fracture injury code, or fracture code with/without a fall code. Participants without fall injuries (N = 1249) were censored over 6.9 ± 2.1 years. Cox regression models for fall injuries with clinically relevant systolic BP (SBP; ≤ 120, ≤ 130, ≤ 140, > 150 mmHg) and diastolic BP (DBP; ≤ 60, ≤ 70, ≤ 80, > 90 mmHg) were adjusted for demographics, body mass index, lifestyle factors, comorbidity, and number and type of medications. Participants with versus without fall injuries had lower DBP (70.5 ± 11.2 vs. 71.8 ± 10.7 mmHg) and used more medications (3.8 ± 2.9 vs. 3.3 ± 2.7); all P < 0.01. In adjusted Cox regression, fall injury risk was increased for DBP ≤ 60 mmHg (HR = 1.25; 95% CI 1.02–1.53) and borderline for DBP ≤ 70 mmHg (HR = 1.16; 95% CI 0.98–1.37), but was attenuated by adjustment for number of medications (HR = 1.22; 95% CI 0.99–1.49 and HR = 1.12; 95% CI 0.95–1.32, respectively). Stratifying by antihypertensive medication, DBP ≤ 60 mmHg increased fall injury risk only among those without use (HR = 1.39; 95% CI 1.02–1.90). SBP was not associated with fall injury risk. Number of medications or underlying poor health may account for associations of low DBP and fall injuries.

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References

  • Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25:71–80

    Article  Google Scholar 

  • Ambrose AF, Paul G, Hausdorff JM (2013) Risk factors for falls among older adults: a review of the literature. Maturitas 75:51–61

    Article  Google Scholar 

  • American Diabetes Association (2015) (2) Classification and diagnosis of diabetes. Diabetes Care 38(Suppl):S8–S16

    Article  Google Scholar 

  • Aronow WS, Fleg JL, Pepine CJ et al (2011) ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol 57:2037–2114

    Article  Google Scholar 

  • Boshuizen HC, Izaks GJ, van Buuren S, Ligthart GJ (1998) Blood pressure and mortality in elderly people aged 85 and older: community based study. BMJ 316:1780–1784

    Article  Google Scholar 

  • Campos AC, de Almeida NA, Ramos AL, Vasconcelos DF, Freitas MP, Toledo MADV (2015) Orthostatic hypotension at different times after standing erect in elderly adults. J Am Geriatr Soc 63:589–590

    Article  Google Scholar 

  • Center for Disease Control and Prevention, National Center for Injury Prevention and Control (2017) Web-based injury statistics query and reporting system (WISQARS). http://www.cdc.gov/injury/wisqars. Accessed 10 July 2017

  • Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 21:1295–1306

    Article  Google Scholar 

  • De Rekeneire N, Visser M, Peila R, Nevitt MC, Cauley JA, Tylavsky FA, Simonsick EM, Harris TB (2003) Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study. J Am Geriatr Soc 51:841–846

    Article  Google Scholar 

  • Ensrud KE (2013) Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci 68:1236–1242

    Article  Google Scholar 

  • Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK (2014) Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 62:2261–2272

    Article  Google Scholar 

  • Gangavati A, Hajjar I, Quach L, Jones RN, Kiely DK, Gagnon P, Lipsitz LA (2011) Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc 59:383–389

    Article  Google Scholar 

  • Harris TB (2003) Aging well and aging poorly: primary and secondary low blood pressure. J Gerontol A Biol Sci Med Sci 58:662–664

    Article  Google Scholar 

  • Harris TB, Savage PJ, Tell GS, Haan M, Kumanyika S, Lynch JC (1997) Carrying the burden of cardiovascular risk in old age: associations of weight and weight change with prevalent cardiovascular disease, risk factors, and health status in the Cardiovascular Health Study. Am J Clin Nutr 66:837–844

    Article  Google Scholar 

  • Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893

    Article  Google Scholar 

  • Kario K, Tobin JN, Wolfson LI, Whipple R, Derby CA, Singh D, Marantz PR, Wassertheil-Smoller S (2001) Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study. J Am Coll Cardiol 38:246–252

    Article  Google Scholar 

  • Kim SB, Zingmond DS, Keeler EB, Jennings LA, Wenger NS, Reuben DB, Ganz DA (2016) Development of an algorithm to identify fall-related injuries and costs in Medicare data. Inj Epidemiol 3:1

    Article  Google Scholar 

  • Klein D, Nagel G, Kleiner A, Ulmer H, Rehberger B, Concin H, Rapp K (2013) Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&PP cohort. BMC Geriatr 13:50

    Article  Google Scholar 

  • Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC (2010) Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine 89:295–299

    Article  Google Scholar 

  • Leipzig RM, Cumming RG, Tinetti ME (1999) Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 47:40–50

    Article  Google Scholar 

  • Marcum ZA, Perera S, Newman AB, Thorpe JM, Switzer GE, Gray SL, Simonsick EM, Shorr RI, Bauer DC, Castle NG, Studenski SA, Hanlon JT (2015) Antihypertensive use and recurrent falls in community-dwelling older adults: findings from the health ABC Study. J Gerontol A Biol Sci Med Sci 70:1562–1568

    Article  Google Scholar 

  • Mattila K, Haavisto M, Rajala S, Heikinheimo R (1988) Blood pressure and five year survival in the very old. Br Med J (Clin Res Ed) 296:887–889

    Article  Google Scholar 

  • Mehta KM, Simonsick EM, Rooks R, Newman AB, Pope SK, RubminSM Yaffe K (2004) Black and white differences in cognitive function test scores: what explains the difference? J Am Geriatr Soc 52:2120–2127

    Article  Google Scholar 

  • Moreira DM, Poffo MR, Miotto R, Matos Sde M, Ferreira AR, de Abreu-Silva EO (2014) Revisiting the J-curve phenomenon. An old new concept? Cur Hypertens Rev 10:14–19

    Article  Google Scholar 

  • Newhouse JP, Price M, Huang J, McWilliams JM, Hsu J (2012) Steps to reduce favorable risk selection in Medicare Advantage largely succeeded, boding well for health insurance exchanges. Health Aff 31:2618–2628

    Article  Google Scholar 

  • Newman AB, Haggerty CL, Goodpaster B, Harris T, Kritchevsky S, Nevitt M, Miles TP, Visser M (2003) Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 51:323–330

    Article  Google Scholar 

  • O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epodemiol 137:342–354

    Article  Google Scholar 

  • Odden MC, Peralta CA, Haan MN, Covinsky KE (2012) Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 172:1162–1168

    Article  Google Scholar 

  • Odden MC, Wu C, Shlipak MG, Psaty BM, Katz R, Applegate WB, Harris T, Newman AB, Peralta CA (2016) Blood pressure trajectory, gait speed, and outcomes: the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 71:1688–1694

    Article  Google Scholar 

  • Orces CH, Alamgir H (2014) Trends in fall-related injuries among older adults treated in emergency departments in the USA. Inj Prev 20:421–423

    Article  Google Scholar 

  • Pahor M, Chrischilles EA, Guralnik JM, Brown SL, Wallace RB, Carbonin P (1994) Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol 10:405–411

    Article  Google Scholar 

  • Protogerou AD, Safar ME, Iaria P, Safar H, Le Dudal K, Filipovsky J, Henry O, Ducimetiere P, Blacher J (2007) Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension 50:172–180

    Article  Google Scholar 

  • Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45:703–714

    Article  Google Scholar 

  • Roberts RE, Vernon SW (1983) The Center for Epidemiologic Studies Depression Scale: its use in a community sample. Am J Psychiatry 140:41–46

    Article  Google Scholar 

  • Shaw BH, Claydon VE (2014) The relationship between orthostatic hypotension and falling in older adults. Clin Auton Res 24:3–13

    Article  Google Scholar 

  • Shlipak MG, Wassel Fyr CL, Chertow GM, Harris TB, Kritchevsky SB, Tylavsky FA, Satterfield S, Cummings SR, Newman AB, Fried LF (2006) Cystatin C and mortality risk in the elderly: the health, aging, and body composition study. J Am Soc Nephrol 17:254–261

    Article  Google Scholar 

  • Sillesen H, Falk E (2011) Peripheral artery disease (PAD) screening in the asymptomatic population: why, how, and who? Curr Atheroscler Rep 13:390–395

    Article  Google Scholar 

  • Sirois C, Moisan J, Poirier P, Couture J, Gregoire JP (2009) Association between age and the initiation of antihypertensive, lipid lowering and antiplateletet medications in elderly individuals newly treated with antidiabetic drugs. Age Ageing 38:741–745

    Article  Google Scholar 

  • Stel VS, Smit JH, Pluijm SM, Lips P (2004) Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing 33:58–65

    Article  Google Scholar 

  • Strotmeyer ES, Arnold AM, Boudreau RM, Ives DG, Cushman M, Robbins JA, Harris TB, Newman AB (2010) Long-term retention of older adults in the Cardiovascular Health Study: implications for studies of the oldest old. J Am Geriatr Soc 58:696–701

    Article  Google Scholar 

  • Supiano MA, Williamson JD (2017) Applying the systolic blood pressure intervention trial results to older adults. J Am Geriatr Soc 65:16–21

    Article  Google Scholar 

  • Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Eng J Med 337:1279–1284

    Article  Google Scholar 

  • Tinetti ME, Han L, Lee DS, McAvay GJ, Peduzzi P, Gross CP, Zhou B, Lin H (2014) Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 174:588–595

    Article  Google Scholar 

  • Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P (2001) Fall-risk screening test: a prospective study on predictors for falls in community-dwelling edlerly. J Clin Epidemiol 54:837–844

    Article  Google Scholar 

  • van Hateren KJ, Landman GW, Kleefstra N, Groenier KH, Kamper AM, Houweling ST, Bilo HJ (2010) Lower blood pressure associated with higher mortality in elderly diabetic patients (ZODIAC-12). Age Ageing 39:603–609

    Article  Google Scholar 

  • Verma SK, Willetts JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK (2016) Falls and fall-related injuries among community-dwelling adults in the United States. PLoS ONE 11:e0150939. https://doi.org/10.1371/journal.pone.0150939

    Article  Google Scholar 

  • Ward RE, Boudreau RM, Vinik AI, Zivkovic SA, Njajou OT, Satterfield S, Harris TB, Newman AB, Strotmeyer ES (2013) Reproducibility of peroneal motor nerve conduction measurement in older adults. Clin Neurophysiol 124:603–609

    Article  Google Scholar 

  • Ward RE, Boudreau RM, Caserotti P, Harris TB, Zivkovic S, Goodpaster BH, Satterfield S, Kritchevsky SB, Schwartz AV, Vinik AI, Cauley JA, Simonsick EM, Newman AB, Strotmeyer ES (2014) Sensory and motor peripheral nerve function and incident mobility disability. J Am Geriatr Soc 62:2273–2279

    Google Scholar 

  • Wiens M, Etminan M, Gill SS, Takkouche B (2006) Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies. J Intern Med 260:350–362

    Article  Google Scholar 

  • Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 169:1952–1960

    Article  Google Scholar 

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Funding

This research was supported by the National Institute on Aging (NIA) Contracts N01-AG-6-2101; N01-AG-6-2103; N01-AG-6-2106; NIA Grant R01-AG028050, and National Institute of Nursing Research Grant R01-NR12459; and in part by the Intramural Research Program of the NIH, NIA.

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Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    Naoko Sagawa, Robert M. Boudreau, Joseph T. Hanlon, Jane A. Cauley, Anne B. Newman & Elsa S. Strotmeyer

  2. School of Pharmacy, University of Washington, 1959 NE Pacific St, H375G, Box 357630, Seattle, WA, 98195, USA

    Zachary A. Marcum

  3. Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 3471 Fifth Ave, Kaufman Medical Building, Suite 500, Pittsburgh, PA, 15213, USA

    Joseph T. Hanlon & Anne B. Newman

  4. Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    Steven M. Albert

  5. School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, 2, Ireland

    Celia O’Hare

  6. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Suzanne Satterfield

  7. Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA

    Ann V. Schwartz

  8. Strelitz Endocrine and Metabolic Center and Neuroendocrine Unit, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA

    Aaron I. Vinik

  9. Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute On Aging, National Institute of Health, 7201 Wisconsin Avenue, Gateway Building, Suite 2N300, Bethesda, MD, 20814, USA

    Tamara B. Harris

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  1. Naoko Sagawa
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Correspondence to Elsa S. Strotmeyer.

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Sagawa, N., Marcum, Z.A., Boudreau, R.M. et al. Low blood pressure levels for fall injuries in older adults: the Health, Aging and Body Composition Study. Eur J Ageing 15, 321–330 (2018). https://doi.org/10.1007/s10433-017-0449-9

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