A study published on April 22, 2024 in the medical journal JAMA Internal Medicine entitled “Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents” concluded: “Findings indicated that initiation of antihypertensive medication was associated with elevated risks of fractures and falls. These risks were numerically higher among residents with dementia, higher baseline blood pressures values, and no recent antihypertensive medication use. Caution and additional monitoring are advised when initiating antihypertensive medication in this vulnerable population.”
The researchers employed a retrospective cohort study using target trial emulation for data derived from 29 ,648 older long-term care nursing home residents in the Veterans Health Administration (VA) from January 1, 2006 to October 31, 2019, to assess the association between antihypertensive medication initiation and risk of fracture. The primary outcome was nontraumatic fracture of the humerus, hip, pelvis, radius, or ulna within 30 days of antihypertensive medication initiation.
The incidence rate of fractures per 100 person-years in residents initiating antihypertensive medication was 5.4 compared with 2.2 in the control arm. Antihypertensive medication initiation was also associated with higher risk of severe falls requiring hospitalizations or emergency department visits and syncope. The magnitude of fracture risk was numerically higher among subgroups of residents with dementia, systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 80 mm Hg or higher, and no recent antihypertensive medication use.
A comment to the published study stated: “I want to thank the authors for this very important research concluding the dangerous of anti-hypertension overtreatment in this frail population. I postulate that mismeasurement of the blood pressure contributed to the overtreatment with medication. This has been reported for the hospitalized population resulting in increased ICU admissions and acute kidney failure. Most nursing home measurements are not performed with the patient sitting in a chair for 5 minutes prior to measurements. Supine blood pressures and measurements without a proper rest period result in artificial elevated readings which can lead to overtreatment and injury. Repeated proper measurements over days to weeks before increasing anti-hypertensive treatment may prevent increased falls and injuries.”
Another comment stated: “For a non-RCT, the methodology utilized by the authors provides pretty compelling and entirely plausible results, that adding a BP med or initiating a BP med in an older population of nursing home residents increases the risk of falls, and hence fractures (as well as probably brain trauma and mortality, via the probably mechanism of orthostatic hypotension.
While I follow a large population of patients with osteoporosis (but almost completely lacking dementia or benzodiazepine use or other risk factors), and ALWAYS stress the importance of fall prevention, this population of veterans comprises a particularly vulnerable population of patients at increased risk of falls and fractures. The results of this study highlights the importance of elevating the importance of fall prevention in nursing homes, especially in patients recently started on anti-hypertensive therapy.”
If you or a loved one suffered injuries (or worse) while a resident of a VA nursing home due to nursing home neglect, nursing home negligence, nursing home abuse, nursing home understaffing, nursing home fall, nursing home fracture, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home claim lawyer in your state who may investigate your nursing home claim for you and file a nursing home claim on your behalf or behalf of your loved one, if appropriate.
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