BP-lowering meds up risk of fractures in older people

Older people who are initiating blood pressure (BP)-lowering medications appear to be at heightened risk of fractures, especially those who have dementia, as shown in a retrospective cohort study.

For the study, researchers used target trial emulation for data obtained from 29,648 older residents (mean age 78.0 years, 97.7 percent male) of long-term care nursing home in the Veterans Health Administration. Nontraumatic fracture of the humerus, hip, pelvis, radius, or ulna within 30 days of BP-lowering medication initiation was assessed as the primary outcome.

Propensity score matching was used in the analyses, with the primary outcome evaluated across subgroups defined by the presence of dementia, by systolic and diastolic BP thresholds of 140 and 80 mm Hg, respectively, and by use of prior antihypertensive therapies.

In a propensity score–matched cohort comprising 64,710 residents (mean age 77.9 years), fractures occurred more frequently among residents who did versus did not initiate antihypertensive medication (incidence rate, 5.4 vs 2.2 per 100 person-years). Antihypertensive medication initiation was associated with a more than twofold increased risk of incident fracture (adjusted hazard ratio [HR], 2.42, 95 percent confidence interval [CI], 1.43-4.08), with an adjusted excess risk of 3.12 per 100 person-years.

Additionally, BP-lowering medication initiation correlated with higher risk of severe falls requiring hospitalizations or emergency department visits (HR, 1.80, 95 percent CI, 1.53–2.13) and syncope (HR, 1.69, 95 percent CI, 1.30–2.19).

The risk of fracture associated with the initiation of BP-lowering medications was numerically higher among subgroups of residents with dementia (HR, 3.28, 95 percent CI, 1.76–6.10), systolic BP ≥140 mm Hg (HR, 3.12, 95 percent CI, 1.71–5.69), diastolic BP ≥80 mm Hg (HR, 4.41, 95 percent CI, 1.67–11.68), and no recent antihypertensive medication use (HR, 4.77, 95 percent CI, 1.49–15.32).

The findings underscore the importance of exercising caution and additional monitoring when initiating antihypertensive medication in this vulnerable population.