In a 1:4 propensity score-matched cohort of 64,710 residents, initiation of antihypertensive medication was associated with an increased risk of fracture and an adjusted excess risk per 100 person-years. This risk was numerically higher in subgroups of residents with dementia or with systolic blood pressure of 140 mm Hg or greater or diastolic blood pressure of 80 mm Hg or greater.
The findings of this cohort study suggest that caution and additional monitoring are recommended when initiating antihypertensive medication in this vulnerable population.
There is limited evidence on the association between initiation of antihypertensive medication and fracture risk in older long-term nursing home residents.
This was a retrospective cohort study using objective trial emulation for data derived from 29,648 older long-term care nursing home residents in the Veterans Health Administration (VA) from January 1, 2006 to January 31. October 2019. Data was analyzed from December 1, 2021 to November 11, 2023.
Exposure episodes were identified at the initiation of antihypertensive medication, and eligible initiation episodes were compared with comparable controls who did not initiate therapy.
The primary outcome was nontraumatic fracture of the humerus, hip, pelvis, radius, or ulna within 30 days of starting antihypertensive medication. Results were calculated among subgroups of residents with dementia, with systolic and diastolic blood pressure thresholds of 140 and 80 mm Hg, respectively, and with the use of prior antihypertensive therapies. Analyzes were adjusted for more than 50 baseline covariates using 1:4 propensity score matching.
Data from 29,648 individuals (mean [SD] age, 78.0 [8.4] years; 28,952 [97.7%] men) were included in this study.
In the propensity score-matched cohort of 64,710 residents (mean [SD] age, 77.9 [8.5] years), the fracture incidence rate per 100 person-years in residents who initiated antihypertensive medication was 5 .4 compared to 2.2 in the control group. This finding corresponded to an adjusted hazard ratio (HR) of 2.42 (95% CI, 1.43-4.08) and an adjusted excess hazard per 100 person-years of 3.12 (95% CI). , 0.95-6.78).
Initiation of antihypertensive medication was also associated with an increased risk of serious falls requiring hospitalizations or emergency department visits (HR, 1.80 [95% CI, 1.53-2.13]) and syncope (HR, 1.69 [95% CI, 1.30-2.19]).
The magnitude of fracture risk was numerically greater among subgroups of residents with dementia (HR, 3.28 [95% CI, 1.76-6.10]), systolic blood pressure of 140 mm Hg or higher (HR, 3 .12 [95% CI, 1.71-5.69]). ]), diastolic blood pressure of 80 mm Hg or greater (HR, 4.41 [95% CI, 1.67-11.68]), and no recent use of antihypertensive medications (HR, 4.77 [95% CI, 1.67-11.68] %, 1.49-15.32]).
Findings indicated that initiation of antihypertensive medication was associated with elevated risks of fractures and falls. These risks were numerically higher among residents with dementia, higher baseline blood pressure values, and no recent use of antihypertensive medications. Additional caution and monitoring is recommended when initiating antihypertensive medication in this vulnerable population.
