Highlights at the American Geriatrics Society included a presentation looking at antihypertensive drug de-intensification and recurrent falls in long-term care. This was presented by Kenneth Boockvar.
Peter Sayer reports from the 2018 American Geriatrics Society annual scientific meeting, Orlando, Florida.
An increased risk for falls is a concern for older adults who pursue “aggressive” targets for lowering high blood pressure, often defined as targeting a systolic blood pressure (or “SBP”—the first of two numbers comprising your blood pressure reading) of less than 120mmHg.
Little is known, however, about links between recurrent falls and less stringent blood pressure targets pursued through “de-intensified” blood pressure treatment. To explore that connection, researchers from New York and California looked at data from American veterans older than 65 who had hypertension treated with one or more of five commonly-used classes of medication.
The researchers looked specifically at veterans who fell three days or fewer after an SBP reading of 101- 120mmHg or 80-100mmHg, suggesting aggressive blood pressure control. The researchers then looked at whether the person’s treatment had been de-intensified (defined as decreasing the dose or discontinuing a medication for high blood pressure). The researchers then compared the 30-day risk for another fall among veterans who did and did not have their high blood pressure treatment de-intensified.
The 30-day subsequent fall risk was lower in some but not all people with de-intensified blood pressure control. Among VA nursing home residents who had a fall and a low SBP, between 25% and 34% had their hypertension treatment deintensified. Among these, individuals with the lower blood pressure levels (an SBP of 80-100mmHG) had a significantly lower risk for falling again within 30 days of their first fall. According to the researchers, findings suggest that blood pressure medication de-intensification may reduce recurrent falls in some nursing home residents with more aggressive blood pressure targets.