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Health See other Health Articles Title: Starting BP Meds Ups Risk of Hip Fracture in Elderly SCARBOROUGH, Ontario — The risk of a hip fracture in people aged 66 and over is increased by almost 50% in the first month and a half after they begin taking medication for high blood pressure, a new study illustrates [1]. In a study published online November 19, 2012 in the Archives of Internal Medicine, Dr Debra A Butt (Ellesmere Health Care Center, Scarborough, ON) and colleagues say much of the medical literature on the association of antihypertensive drug use and fractures has focused on long exposure periods. "To our knowledge, this is the first study to demonstrate an immediate increased risk of hip fracture on initiation of antihypertensive drug therapy in community-dwelling hypertensive elderly patients," they observe. This is the first study to demonstrate an immediate increased risk of hip fracture on initiation of antihypertensive drug therapy. They say that the most likely mechanism at play here is orthostatic hypotension as a result of starting antihypertensive drugs, which is associated with dizziness and fainting. The effect is acute, occurs over a relatively short time, and may lead to falls, some of which can result in hip fractures. "Physicians need to be aware of the effect of drug therapies on fracture risk because it may have important implications for the elderly population and the healthcare system," they assert. Immediate Period After Start of Therapy Compared With Control Periods Butt and colleagues used the Ontario Drug Benefit Program (ODBP) prescription-drugs database to identify all residents aged 66 and older with a first prescription of an antihypertensive drug (thiazide diuretics, ACE inhibitors, angiotensin-receptor blockers, calcium-channel blockers, or beta blockers). This cohort was linked to information on hip fractures from various national databases from April 1, 2000 to March 2009. The risk period was the first 45 days following antihypertensive therapy initiation compared with control periods before and after treatment in a 450-day observation period. Patients with a variety of preexisting conditions, such as diabetes, certain cardiovascular events, and renal disease, were excluded, as were people residing in long-term-care homes. Caution is advised when initiating antihypertensive drugs in the elderly. The main outcome measure was first occurrence of a hip fracture (proximal femoral fracture). Among the 301 591 newly treated hypertensive community-dwelling elderly people, 1463 hip fractures were identified during the observation period. Hypertensive people who began receiving medication for high blood pressure had a 43% increased risk of having a hip fracture during the first 45 days following the start of therapy relative to the control periods (incidence rate ratio 1.43; CI 1.19-1.72). The researchers note that it was not possible to determine risks for specific subclasses of antihypertensives or for different drug doses. "Antihypertensive drugs were associated with an immediate increased hip fracture risk during the initiation of treatment. Caution is advised when initiating antihypertensive drugs in the elderly," Butt and colleagues conclude. Post Comment Private Reply Ignore Thread
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