Drugs & Aging

, Volume 35, Issue 7, pp 625–635 | Cite as

A Systematic Review and Meta-Analyses of the Association Between Anti-Hypertensive Classes and the Risk of Falls Among Older Adults

  • Hui Ting Ang
  • Ka Keat Lim
  • Yu Heng Kwan
  • Pui San Tan
  • Kai Zhen Yap
  • Zafirah Banu
  • Chuen Seng Tan
  • Warren Fong
  • Julian Thumboo
  • Truls Ostbye
  • Lian Leng LowEmail author
Systematic Review



Falls in individuals aged ≥ 60 years may result in injury, hospitalisation or death. The role of anti-hypertensive medications in falls among older adults is unclear.


The objective of this study was to assess the association of six anti-hypertensive medication classes, namely α-blockers (AB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), β-blockers (BB), calcium channel blockers (CCB) and diuretics, with the risk of falls, injurious falls or recurrent falls in individuals aged ≥ 60 years compared with non-users.


We performed systematic searches in PubMed, EMBASE and CINAHL and included cohort, case-control and cross-sectional studies that investigated the associations between the use of anti-hypertensive medication classes and the risk of falls, injurious falls or recurrent falls in older adults (≥ 60 years) reported in English. We assessed study quality using the Newcastle-Ottawa Scale (NOS). Unadjusted and adjusted odds ratios (ORs) were pooled using random effects model. We performed meta-analyses for each anti-hypertensive medication class and each fall outcome. We also performed sensitivity analyses by pooling studies of high quality and subgroup analyses among studies with an average age of ≥ 80 years.


Seventy-eight articles (where 74, 34, 27, 18, 13 and 11 of them examined diuretics, BB, CCB, ACEi, AB and ARB, respectively) met our inclusion and exclusion criteria; we pooled estimates from 60 articles. ACEi [OR 0.85, 95% confidence interval (CI) 0.81–0.89], BB (OR 0.84, 95% CI 0.76–0.93) and CCB (OR 0.81, 95% CI 0.74–0.90) use were associated with a lower risk of injurious falls than in non-users. Results in sensitivity and subgroup analyses were largely consistent.


The use of ACEi, BB or CCB among older adults may be associated with a lower risk of injurious falls than non-use.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflict of interest

H.T. Ang, K.K. Lim, Y.H. Kwan, P.S. Tan, K.Z. Yap, Z. Banu, C.S. Tan, W. Fong, J. Thumboo, T. Ostbye and L.L. Low declare that they have no conflicts of interest that might be relevant to the contents of this systematic review.

Supplementary material

40266_2018_561_MOESM1_ESM.docx (973 kb)
Supplementary material 1 (DOCX 973 kb)


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Authors and Affiliations

  • Hui Ting Ang
    • 1
  • Ka Keat Lim
    • 2
  • Yu Heng Kwan
    • 2
  • Pui San Tan
    • 3
  • Kai Zhen Yap
    • 1
  • Zafirah Banu
    • 1
  • Chuen Seng Tan
    • 4
  • Warren Fong
    • 5
    • 6
    • 7
  • Julian Thumboo
    • 2
    • 5
  • Truls Ostbye
    • 2
  • Lian Leng Low
    • 7
    • 8
    • 9
    Email author
  1. 1.Department of Pharmacy, Faculty of ScienceNational University of SingaporeSingaporeRepublic of Singapore
  2. 2.Program in Health Services and Systems ResearchDuke-NUS Medical SchoolSingaporeRepublic of Singapore
  3. 3.Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
  4. 4.Saw Swee Hock School of Public Health, Tahir Foundation BuildingNational University of SingaporeSingaporeRepublic of Singapore
  5. 5.Department of Rheumatology and ImmunologySingapore General HospitalSingaporeRepublic of Singapore
  6. 6.Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  7. 7.Duke-NUS Medical SchoolSingaporeRepublic of Singapore
  8. 8.Department of Family Medicine and Continuing CareSingapore General HospitalSingaporeRepublic of Singapore
  9. 9.SingHealth Duke-NUS Family Medicine Academic Clinical ProgramSingaporeRepublic of Singapore

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