A Systematic Review and Meta-Analyses of the Association Between Anti-Hypertensive Classes and the Risk of Falls Among Older Adults
- 407 Downloads
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.
- 2.National Institue for Health and Care Excellence (NICE). Assessment and prevention of falls in older people. London: National Institue for Health and Care Excellence (NICE); 2013.Google Scholar
- 5.Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol. 2007;62A(10):1172–81.Google Scholar
- 13.Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev. 2012(8):CD006742.Google Scholar
- 14.Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses Ontario, Canada. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 26 Aug 2017.
- 19.Sterne J, Egger M, Moher D. Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of intervention. 5.1.0. London: The Cochrane Collaboration; 2011.Google Scholar
- 21.Rodger MA, Carrier M, Le Gal G, Martinelli I, Perna A, Rey É, et al. Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group. Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood. 2014;123(6):822–8.PubMedGoogle Scholar
- 28.Corrao G, Mazzola P, Monzio Compagnoni M, Rea F, Merlino L, Annoni G, et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81,617 Italian patients newly treated between 2005 and 2009. Drugs Aging. 2015;32(11):927–36.PubMedGoogle Scholar
- 29.Cumming R, Klineberg R. Psychotropics, thiazide diuretics and hip fractures in the elderly. Med J Aust 1993. 158(6).Google Scholar
- 70.Rashiq S, Logan R. Role of drugs in fractures of the femoral neck. Br Med J (Clin Res Ed). 1986;292(6524):861–3.Google Scholar
- 78.Sernbo I, Hansson A, Johnell O. Drug consumption in patients with hip fractures compared with controls. Compr Gerontol A. 1987;I:93–6.Google Scholar
- 80.Sobel K, McCart G. Drug use and accidental falls in an intermediate care facility. Drug Intell Clin Pharm. 1983;17(7):539–42.Google Scholar
- 81.Solomon D, Mogun H, Garneau K, Fischer M. Risk of fractures in older adults using antihypertensive medications. J Bone Miner Res. 2011;26(7):1561–7.Google Scholar
- 83.Sorock G. A case control study of falling incidents among the hospitalized elderly. J Safety Res. 1983;14(2):47–52.Google Scholar
- 91.Wågert P, Gustafson Y, Kallin K, Jensen J, Lundin-Olsson L. Falls in very old people: the population-based Umea 85 + study in Sweden. Arch Gerontol Geriatr. 2009;49(3):390–6.Google Scholar
- 94.Weiland S, Rückmann A, Keil U, Lewis M, Dennler H, Welzel D. Thiazide diuretics and the risk of hip fracture among 70–79 year old women treated for hypertension. Eur J Public Health. 1997;7(3):335–40.Google Scholar