Within 30 days of antihypertensive medication initiation, the rate of fracture was more than twice as high in initiators than in noninitiators.

Evidence suggests that risks for orthostatic hypotension and falls are elevated immediately after initiation of antihypertensive medication. However, little is known about the association between antihypertensive medication initiation and fracture risk among older nursing home residents, who commonly receive these medications.

In a retrospective cohort study of US Veterans Affairs (VA) nursing home residents during 2006 to 2019, researchers identified 13,000 residents who initiated a first or additional antihypertensive medication and 52,000 propensity score-matched controls (mean age, 78 years). The primary outcome was a composite of pelvic fracture, surgically treated hip fracture and fractures of the humerus, radius and ulna that required intervention within 30 days of starting antihyper- tensive medication.

The rate of incident fracture was 5.4 per 100 person-years among medication initiators and 2.2 per 100 person-years among controls (adjusted hazard ratio [aHR], 2.4). Initiating medication was also associated with elevated risks for falls that required emergency room visits or hospitalisations (aHR, 1.8) and for syncope (aHR, 1.7). Fracture risks were elevated, compared with controls, in initiators with dementia (aHR, 3.3), systolic blood pressure 140 mmHg or higher (aHR, 3.1), diastolic blood pressure 80 mmHg or higher (aHR, 4.4) and no recent antihypertensive medication use (aHR, 4.8).

Comment: Antihypertensive therapy in older patients is often beneficial (e.g. for managing cardiovascular disease). However, this benefit should be weighed against potential harms, including fracture, which can be devastating. The current study also suggests (albeit indirectly) that it would be prudent to check nursing home residents for orthostatic blood pressure changes routinely during the first month after initiating or augmenting antihypertensive therapy.

Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

Dave CV, et al. Antihypertensive medication and fracture risk in older Veterans Health Administration nursing home residents. JAMA Intern Med 2024; 184: 661-669.

This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine, Hospital Medicine, Neurology.