A recent study highlights the association between blood pressure medications and increased fall risk, but there are effective ways to offset the danger.
The Risks of Hypertension
Nearly half of all U.S. adults suffer from hypertension (high blood pressure), a significant risk factor for cardiovascular, kidney, and neurological health issues. Managing blood pressure is crucial for improving healthspan and lifespan, often requiring lifestyle changes and, in some cases, medication. However, no medical intervention is entirely without risk. A recent study has raised concerns about the potential for antihypertensive drugs to increase the risk of falls and related injuries. This article explores the findings and suggests ways to mitigate these risks, including lifestyle approaches like exercise and dietary modifications.
What the Study Found
The retrospective cohort study by Dave et al. analyzed the impact of antihypertensive therapy initiation on fractures among nursing home residents (mean age 78, 97.7% male) within the Veteran’s Administration (VA) system. Researchers reviewed data from 29,648 individuals over nearly 14 years. Patients who initiated new antihypertensive therapy—defined as an increase in the number of medications—were compared with matched controls who did not adjust their antihypertensive regimen.
The study included 12,942 treatment episodes and 51,768 control episodes. Researchers found that initiating new antihypertensive medications nearly doubled the risk of falls requiring emergency care (hazard ratio [HR]: 1.80) and increased the likelihood of fractures (HR: 2.42). Orthostatic hypotension, where blood pressure drops suddenly upon standing, was likely a key contributor.
Implications of the Findings
While the study’s design reduced confounding variables by allowing subjects to serve as their own controls, it had limitations. The population was predominantly male, and specific drug classes and doses were not evaluated. Nonetheless, the findings underscore the importance of addressing fall risks in older adults initiating antihypertensive therapy, particularly during the first month.
Why Falls Occur with Antihypertensive Use
Antihypertensives lower blood pressure, but they may inadvertently cause it to drop too low during postural changes, leading to dizziness or fainting. Other contributing factors include dehydration, age-related vestibular changes, muscle weakness, and slower reaction times.
Managing Hypertension Safely
Despite the potential risks, antihypertensives remain critical for most individuals with high blood pressure. Their benefits in preventing cardiovascular events, kidney disease, and even cognitive decline outweigh the risks of falls when managed appropriately.
However, there are evidence-based alternatives and complementary strategies for managing blood pressure:
- Regular Exercise: Aerobic activities, resistance training, and even walking can significantly reduce blood pressure by improving vascular function and overall cardiovascular health.
- Omega-3 Fatty Acids: Found in fatty fish like salmon, mackerel, and sardines, omega-3s have been shown to lower blood pressure, reduce inflammation, and improve heart health. Supplements are another option for those who cannot consume enough omega-3-rich foods.
- DASH Diet: The Dietary Approaches to Stop Hypertension (DASH) diet emphasises fruits, vegetables, lean proteins, and low sodium intake, which can help regulate blood pressure.
- Stress Management: Techniques such as meditation, yoga, and deep breathing can lower blood pressure by reducing stress-related hormone levels.
- Weight Management: Maintaining a healthy weight reduces the strain on the cardiovascular system, contributing to lower blood pressure.
Preventing Falls
To reduce fall risk, especially after starting antihypertensives:
- Strengthen Muscles and Improve Balance: Resistance training, balance exercises, and activities like Tai Chi enhance lower-limb strength and stability.
- Modify Your Environment: Clear clutter, improve lighting, and use handrails on stairs.
- Stay Hydrated: Proper hydration prevents sudden drops in blood pressure due to reduced blood volume. Monitor hydration by ensuring adequate urine output.
The Bottom Line
The study reinforces the need to exercise caution when initiating antihypertensive medications, particularly during the first month. By complementing medications with lifestyle changes like exercise, omega-3 supplementation, and a healthy diet, you can manage blood pressure effectively while minimising fall risks. Always consult your healthcare provider before making significant changes to your treatment plan.