Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis.

Abstract:

BACKGROUND:Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults. METHODS:Data sources: Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE, and MEDLINE databases from January 1 2007 to June 1 2017. Study selection: Research studies of cohort, case-control, case-crossover, cross-sectional, or randomized controlled trial (RCT) design examining association between antihypertensives and falls in people older than 60 years were evaluated. Data synthesis: Twenty-nine studies (N = 1,234,667 participants) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). PRISMA and MOOSE guidelines were used for abstracting data and random-effects inverse-variance meta-analysis was conducted on 26 articles examining chronic antihypertensive use, with odds ratios (ORs) and hazards ratios (HRs) analyzed separately. Time-risk analysis was performed on 5 articles examining acute use of antihypertensives. Outcomes: Pooled ORs and HRs were calculated to determine the association between chronic antihypertensive use and falls. For time-risk analysis, OR was plotted with respect to number of days since antihypertensive commencement, change, or dose increase. RESULTS:There was no significant association between risk of falling and chronic antihypertensive medication use (OR = 0.97, 95% confidence interval [CI] 0.93-1.01, I2 = 64.1%, P = 0.000; and HR = 0.96, 95% CI 0.92-1.00, I2 = 0.0%, P = 0.706). The time-risk analysis demonstrated a significantly elevated risk of falling 0-24 hours after antihypertensive initiation, change, or dose increase. When diuretics were used, the risk remained significantly elevated till day 21. CONCLUSIONS:There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.

journal_name

Am J Hypertens

authors

Kahlaee HR,Latt MD,Schneider CR

doi

10.1093/ajh/hpx189

subject

Has Abstract

pub_date

2018-03-10 00:00:00

pages

467-479

issue

4

eissn

0895-7061

issn

1941-7225

pii

4566156

journal_volume

31

pub_type

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