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A Systematic Review and Meta-Analyses of the Association Between Anti-Hypertensive Classes and the Risk of Falls Among Older Adults

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A Letter to the Editor to this article was published on 13 November 2018

Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

The use of ACEi, BB or CCB among older adults may be associated with a lower risk of injurious falls than non-use.

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References

  1. Scuffham P, Chaplin S, Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health. 2003;57:740–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

  3. Rubenstein L. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37–41.

    PubMed  Google Scholar 

  4. Woolcott J, Richardson K, Wiens M, Patel B, Marin J, Khan K, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.

    PubMed  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 

  6. Shimbo D, Bowling B, Levitan E, Deng L, Sim J, Huang L, et al. Short-term risk of serious fall injuries in older adults initiating and intensifying treatment with antihypertensive medication. Circ Cardiovasc Qual Outcomes. 2016;9(3):222–9.

    PubMed  PubMed Central  Google Scholar 

  7. Lipsitz L, Gagnon M, Vyas M, Iloputaife I, Kiely D, Sorond F, et al. Antihypertensive therapy increases cerebral blood flow and carotid distensibility in hypertensive elderly subjects. Hypertension. 2005;45(2):216–21.

    CAS  PubMed  Google Scholar 

  8. Leipzig RMC, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47:40–50.

    CAS  PubMed  Google Scholar 

  9. Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud A, Dugué B, et al. Estimation of the risk factors for falls in the elderly: can meta-analysis provide a valid answer? Geriatr Gerontol Int. 2013;13:250–63.

    PubMed  Google Scholar 

  10. Kuschel B, Laflamme L, Moller J. The risk of fall injury in relation to commonly prescribed medications among older people—a Swedish case-control study. Eur J Public Health. 2015;25(3):527–32.

    PubMed  Google Scholar 

  11. Kunutsor S, Blom A, Whitehouse M, Kehoe P, Laukkanen J. Renin-angiotensin system inhibitors and risk of fractures: a prospective cohort study and meta-analysis of published observational cohort studies. Eur J Epidemiol. 2017;32(11):947–59.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Wiens M, Etminan M, Gill S, Takkouche B. Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies. J Intern Med. 2006;260(4):350–62.

    CAS  PubMed  Google Scholar 

  13. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev. 2012(8):CD006742.

  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.

  15. Cheng Y, Huang Z, Shen Z, Wu H, Peng J, Waye MM, et al. ACE inhibitors and the risk of fractures: a meta-analysis of observational studies. Endocrine. 2016;55(3):732–40.

    PubMed  Google Scholar 

  16. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.

    PubMed  Google Scholar 

  17. Bown MJ, Sutton AJ. Quality control in systematic reviews and meta-analyses. Eur J Vasc Endovasc Surg. 2010;40(5):669–77.

    CAS  PubMed  Google Scholar 

  18. Thorell K, Ranstad K, Midlov P, Borgquist L, Halling A. Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study. BMC Geriatr. 2014;14:131.

    PubMed  PubMed Central  Google Scholar 

  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.

  20. Higgins J, Deeks SGT, Altman J. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    PubMed  PubMed Central  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.

    CAS  PubMed  Google Scholar 

  22. Blake A, Morgan K, Bendall M, Dallosso H, Ebrahim S, Arie T, et al. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988;17(6):365–72.

    CAS  PubMed  Google Scholar 

  23. Bohannon A, Hanlon J, Landerman R, Gold D. Association of race and other potential risk factors with nonvertebral fractures in community-dwelling elderly women. Am J Epidemiol. 1999;149(11):1002–9.

    CAS  PubMed  Google Scholar 

  24. Callisaya M, Sharman J, Close J, Lord S, Srikanth V. Greater daily defined dose of antihypertensive medication increases the risk of falls in older people—a population-based study. J Am Geriatr Soc. 2014;62(8):1527–33.

    PubMed  Google Scholar 

  25. Cauley J, Cummings S, Seeley D, Black D, Browner W, Kuller L, et al. Effects of thiazide diuretic therapy on bone mass, fractures, and falls. The Study of Osteoporotic Fractures Research Group. Ann Intern Med. 1993;118(9):666–73.

    CAS  PubMed  Google Scholar 

  26. Chaimowicz F, Ferreira T, Miguel D. Use of psychoactive drugs and related falls among older people living in a community in Brazil. Rev Saude Publica. 2000;34(6):631–5.

    CAS  PubMed  Google Scholar 

  27. Chang C, Chen M, Tsai C, Ho L, Hsieh H, Chau Y, et al. Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study. Int J Geriatr Psychiatry. 2011;26(6):602–7.

    PubMed  Google 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.

    CAS  PubMed  Google Scholar 

  29. Cumming R, Klineberg R. Psychotropics, thiazide diuretics and hip fractures in the elderly. Med J Aust 1993. 158(6).

  30. Cumming R, Miller J, Kelsey J, Davis P, Arfken C, Birge S, et al. Medications and multiple falls in elderly people: the St Louis OASIS study. Age Ageing. 1991;20(6):455–61.

    CAS  PubMed  Google Scholar 

  31. Delafuente J, Meuleman J, Conlin M, Hoffman N, Lowenthal D. Drug use among functionally active, aged, ambulatory people. Ann Pharmacother. 1992;26(2):179–83.

    CAS  PubMed  Google Scholar 

  32. Formiga F, Lopez-Soto A, Duaso E, Ruiz D, Chivite D, Perez-Castejon J, et al. Characteristics of fall-related hip fractures in community-dwelling elderly patients according to cognitive status. Aging Clin Exp Res. 2008;20(5):434–8.

    PubMed  Google Scholar 

  33. Formiga F, Navarro M, Duaso E, Chivite D, Ruiz D, Perez-Castejon J, et al. Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone. 2008;43(5):941–4.

    PubMed  Google Scholar 

  34. Freeland K, Thompson A, Zhao Y, Leal J, Mauldin P, Moran W. Medication use and associated risk of falling in a geriatric outpatient population. Ann Pharmacother. 2012;46(9):1188–92.

    PubMed  Google Scholar 

  35. Frels C, Williams P, Narayanan S, Gariballa S. Iatrogenic causes of falls in hospitalized elderly patients: a case control study. Postgrad Med J. 2002;78(922):487–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. French D, Campbell R, Spehar A, Cunningham F, Bulat T, Luther S. Drugs and falls in community-dwelling older people: a national veterans study. Clin Ther. 2006;28(4):619–30.

    PubMed  Google Scholar 

  37. Gales B, Menard S. Relationship between the administration of selected medications and falls in hospitalized elderly patients. Ann Pharmacother. 1995;29(4):354–8.

    CAS  PubMed  Google Scholar 

  38. Gerdhem P, Ringsberg K, Akesson K, Obrant K. Clinical history and biologic age predicted falls better than objective functional tests. J Clin Epidemiol. 2005;58(3):226–32.

    PubMed  Google Scholar 

  39. Gluck T, Wientjes H, Rai G. An evaluation of risk factors for in-patient falls in acute and rehabilitation elderly care wards. Gerontology. 1996;42(2):104–7.

    CAS  PubMed  Google Scholar 

  40. Graafmans W, Ooms M, Hofstee H, Bezemer P, Bouter L, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996;143:1129–36.

    CAS  PubMed  Google Scholar 

  41. Granek E, Baker S, Abbey H, Robinson E, Myers A, Sarnkof J, et al. Medications and diagnoses in relation to falls in a long-term-care facility. J Am Geriatr Soc. 1987;35(6):503–11.

    CAS  PubMed  Google Scholar 

  42. Gribbin J, Hubbard R, Gladman J, Smith C, Lewis S. Risk of falls associated with antihypertensive medication: population-based case-control study. Age Ageing. 2010;39(5):592–7.

    PubMed  Google Scholar 

  43. Guo Z, Wills P, Viitanen M, Fastbom J, Winblad B. Cognitive impairment, drug use, and the risk of hip fracture in persons over 75 years old: a community-based prospective study. Am J Epidemiol. 1998;148(9):887–92.

    CAS  PubMed  Google Scholar 

  44. Ham A, Swart K, Enneman A, van Dijk S, Oliai Araghi S, van Wijngaarden J, et al. Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging. 2014;31(12):917–27.

    CAS  PubMed  Google Scholar 

  45. Hanlon J, Landerman L, Fillenbaum G, Studenski S. Falls in African American and white community-dwelling elderly residents. J Gerontol A Biol Sci Med Sci. 2002;57(7):M473–8.

    PubMed  Google Scholar 

  46. Hasegawa J, Kuzuya M, Iguchi A. Urinary incontinence and behavioral symptoms are independent risk factors for recurrent and injurious falls, respectively, among residents in long-term care facilities. Arch Gerontol Geriatr. 2010;50(1):77–81.

    PubMed  Google Scholar 

  47. Homer M, Palmer N, Fox K, Armstrong J, Mandl K. Predicting falls in people aged 65 years and older from insurance claims. Am J Med. 2017;130(6):744.e17–744.e23.

    PubMed  PubMed Central  Google Scholar 

  48. Iinattiniemi S, Jokelainen J, Luukinen H. Falls risk among a very old home-dwelling population. Scand J Prim Health Care. 2009;27(1):25–30.

    PubMed  PubMed Central  Google Scholar 

  49. Jensen J, Nielsen L, Lyhne N, Hallas J, BkØsen K, Gram L. Drugs and femoral neck fracture: a case-control study. J Intern Med. 1991;229:29–33.

    CAS  PubMed  Google Scholar 

  50. Kallin K, Jensen J, Olsson L, Nyberg L, Gustafson Y. Why the elderly fall in residential care facilities, and suggested remedies. J Fam Pract. 2004;53(1):41–52.

    PubMed  Google Scholar 

  51. Kario K, Tobin J, Wolfson L, Whipple R, Derby C, Singh D, et al. Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study. J Am Coll Cardiol. 2001;38(1):246–52.

    CAS  PubMed  Google Scholar 

  52. Kerman M, Mulvihill M. The role of medication in falls among the elderly in a long-term care facility. Mt Sinai J Med. 1990;57(6):343–7.

    CAS  PubMed  Google Scholar 

  53. Koski K, Luukinen H, Laippala P, Kivela S. Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing. 1996;25(1):29–38.

    CAS  PubMed  Google Scholar 

  54. Kuschel B, Laflamme L, Moller J. The risk of fall injury in relation to commonly prescribed medications among older people—a Swedish case-control study. Eur J Public Health. 2015;25(3):527–32.

    PubMed  Google Scholar 

  55. Lacroix A. Thiazide diuretic agents and prevention of hip fracture. Compr Ther. 1991;17(8):30–9.

    CAS  PubMed  Google Scholar 

  56. Lee J, Kwok T, Leung P, Woo J. Medical illnesses are more important than medications as risk factors of falls in older community dwellers?A cross-sectional study. Age Ageing. 2006;35(3):246–51.

    PubMed  Google Scholar 

  57. Lim L, Fink H, Blackwell T, Taylor B, Ensrud K. Loop diuretic use and rates of hip bone loss and risk of falls and fractures in older women: clinical investigations. J Am Geriatr Soc. 2009;57(5):855–62.

    PubMed  PubMed Central  Google Scholar 

  58. Lipsitz L, Habtemariam D, Gagnon M, Iloputaife I, Sorond F, Tchalla A, et al. Reexamining the effect of antihypertensive medications on falls in old age. Hypertension. 2015;66(1):183–9.

    CAS  PubMed  Google Scholar 

  59. Liu B, Topper A, Reeves R, Gryfe C, Maki B. Falls among older people: relationship to medication use and orthostatic hypotension. J Am Geriatr Soc. 1995;43(10):1141–5.

    CAS  PubMed  Google Scholar 

  60. Luukinen H, Koski K, Laippala P, Kivela S. Risk factors for recurrent falls in the elderly in long-term institutional care. Public Health. 1995;109(1):57–65.

    CAS  PubMed  Google Scholar 

  61. Makhlouf M, Ayoub A. Falls among institutionalized elderly in Alexandria. J Egypt Public Health Assoc. 2000;75(5–6):507–28.

    CAS  PubMed  Google Scholar 

  62. Mamun K, Lim J. Association between falls and high-risk medication use in hospitalized Asian elderly patients. Geriatr Gerontol Int. 2009;9(3):276–81.

    PubMed  Google Scholar 

  63. Marcum Z, Perera S, Newman A, Thorpe J, Switzer G, Gray S, et al. Antihypertensive use and recurrent falls in community-dwelling older adults: findings from the Health ABC study. J Gerontol A Biol Sci Med Sci. 2015;70(12):1562–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Myers A, Baker S, Van Natta M, Abbey H, Robinson E. Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol. 1991;133(11):1179–90.

    CAS  PubMed  Google Scholar 

  65. Myers A, Van Natta M, Robinson E, Baker S. Can injurious falls be prevented? J Long Term Care Adm. 1994;22(2):26–32.

    CAS  PubMed  Google Scholar 

  66. Nguyen T, Eisman J, Kelly P, Sambrook P. Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol. 1996;144(3):255–63.

    CAS  PubMed  Google Scholar 

  67. Perez-Ros P, Martinez-Arnau F, Malafarina V, Tarazona-Santabalbina F. A one-year proprioceptive exercise programme reduces the incidence of falls in community-dwelling elderly people: a before-after non-randomised intervention study. Maturitas. 2016;94:155–60.

    PubMed  Google Scholar 

  68. Polinder-Bos H, Emmelot-Vonk M, Gansevoort R, Diepenbroek A, Gaillard C. High fall incidence and fracture rate in elderly dialysis patients. Neth J Med. 2014;72(10):509–15.

    CAS  PubMed  Google Scholar 

  69. Prudham D, Evans J. Factors associated with falls in the elderly: a community study. Age Ageing. 1981;10(3):141–6.

    CAS  PubMed  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.

    CAS  Google Scholar 

  71. Ray W, Griffin M, Downey W, Melton LJ 3rd. Long-term use of thiazide diuretics and risk of hip fracture. Lancet. 1989;1(8640):687–90.

    CAS  PubMed  Google Scholar 

  72. Reid I, Gamble G, Grey A, Black D, Ensrud K, Browner W, et al. β-Blocker use, BMD, and fractures in the study of osteoporotic fractures. J Bone Miner Res. 2005;20(4):613–8.

    CAS  PubMed  Google Scholar 

  73. Rhalimi M, Helou R, Jaecker P. Medication use and increased risk of falls in hospitalized elderly patients: a retrospective, case–control study. Drugs Aging. 2009;26(10):847–52.

    CAS  PubMed  Google Scholar 

  74. Rojas-Fernandez C, Dadfar F, Wong A, Brown S. Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada. BMC Res Notes. 2015;8:568.

    PubMed  PubMed Central  Google Scholar 

  75. Rossini M, Viapiana O, Adami S, Idolazzi L, Buda S, Veronesi C, et al. Medication use before and after hip fracture: a population-based cohort and case-control study. Drugs Aging. 2014;31(7):547–53.

    CAS  PubMed  Google Scholar 

  76. Rozenfeld S, Camacho L, Veras P. Medication as a risk factor for falls in older women in Brazil. Rev Panam Salud Publica. 2003;13(6):369–75.

    PubMed  Google Scholar 

  77. Ruths S, Bakken M, Ranhoff A, Hunskaar S, Engesaeter L, Engeland A. Risk of hip fracture among older people using antihypertensive drugs: a nationwide cohort study. BMC Geriatr. 2015;15:153.

    PubMed  PubMed Central  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 

  79. Simonson W, Han L, Davidson H. Hypertension treatment and outcomes in US nursing homes: results from the US national nursing home survey. J Am Med Dir Assoc. 2011;12(1):44–9.

    PubMed  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.

  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.

    CAS  PubMed  Google Scholar 

  82. Song H, Lee J, Kim Y, Jung S, Kim H, Choi N, et al. beta1 selectivity of beta-blockers and reduced risk of fractures in elderly hypertension patients. Bone. 2012;51(6):1008–15.

    CAS  PubMed  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 

  84. Stegman M. Falls among elderly hypertensives—are they iatrogenic? Gerontology. 1983;29(6):399–406.

    CAS  PubMed  Google Scholar 

  85. Stevens A, Mulrow C. Drugs affecting postural stability and other risk factors in the hip fracture epidemic—case–control study. Community Med. 1989;11(1):27–34.

    CAS  PubMed  Google Scholar 

  86. Svensson M, Rundgren Å, Landahl S. Falls in 84- to 85-year -old people living at home. Accid Anal Prev. 1992;24(5):527–37.

    CAS  PubMed  Google Scholar 

  87. Taggart H. Do drugs affect the risk of hip fracture in elderly women? J Am Geriatr Soc. 1988;36(11):1006–10.

    CAS  PubMed  Google Scholar 

  88. Tinetti M, Han L, Lee D, McAvay G, Peduzzi P, Gross C, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588–95.

    PubMed  PubMed Central  Google Scholar 

  89. Turner J, Tervonen H, Shakib S, Singhal N, Prowse R, Bell J. Factors associated with use of falls risk increasing drugs among patients of a geriatric oncology outpatient clinic in Australia: a cross-sectional study. J Eval Clin Pract. 2017;23(2):361–8.

    PubMed  Google Scholar 

  90. Vassallo M, Sharma J, Briggs R, Allen S. Characteristics of early fallers on elderly patient rehabilitation wards. Age Ageing. 2003;32(3):338–42.

    PubMed  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 

  92. Walker P, Alrawi A, Mitchell J, Regal R, Khanderia U. Medication use as a risk factor for falls among hospitalized elderly patients. Am J Health Syst Pharm. 2005;62(23):2495–9.

    PubMed  Google Scholar 

  93. Wang P, Bohn R, Glynn R, Mogun H, Avorn J. Zolpidem use and hip fractures in older people. J Am Geriatr Soc. 2001;49(12):1685–90.

    CAS  PubMed  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 

  95. Whitney J, Close J, Jackson S, Lord S. Understanding risk of falls in people with cognitive impairment living in residential care. J Am Med Dir Assoc. 2012;13(6):535–40.

    PubMed  Google Scholar 

  96. Wong A, Lord S, Sturnieks D, Delbaere K, Trollor J, Close J. Angiotensin system-blocking medications are associated with fewer falls over 12 months in community-dwelling older people. J Am Geriatr Soc. 2013;61(5):776–81.

    PubMed  Google Scholar 

  97. Yip Y, Cumming R. The association between medications and falls in Australian nursing-home residents. Med J Aust. 1994;160(1):14–8.

    CAS  PubMed  Google Scholar 

  98. Zia A, Kamaruzzaman S, Tan M. The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls. Geriatr Gerontol Int. 2017;17(3):463–70.

    PubMed  Google Scholar 

  99. Yang S, Nguyen N, Center J, Eisman J, Nguyen T. Association between beta-blockers and fracture risk: a Bayesian meta-analysis. Bone. 2012;51:969–74.

    CAS  PubMed  Google Scholar 

  100. Toulis K, Hemming K, Stergianos S, Nirantharakumar K, Bilezikian J. β-adrenergic receptor antagonists and fracture risk: a meta-analysis of selectivity, gender, and site-specific effects. Osteoporos Int. 2013;25:121–9.

    PubMed  Google Scholar 

  101. Danna N, Beutel B, Campbell K, Bosco J. Therapeutic approaches to skeletal muscle repair and healing. Sports Health. 2014;6(4):348–55.

    PubMed  PubMed Central  Google Scholar 

  102. Kang KY, Kang Y, Kim M, Kim Y, Yi H, Kim J, et al. The effects of antihypertensive drugs on bone mineral density in ovariectomized mice. J Korean Med Sci. 2013;28(8):1139–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  103. Kwok T, Leung J, Zhang YF, Bauer D, Ensrud KE, Barrett-Connor E, et al. Does the use of ACE inhibitors or angiotensin receptor blockers affect bone loss in older men? Osteoporos Int. 2012;23(8):2159–67.

    CAS  PubMed  Google Scholar 

  104. Pasco J, Henry M, Sanders K, Kotowicz M, Seeman E, Nicholson G, et al. Beta-adrenergic blockers reduce the risk of fracture partly by increasing bone mineral density: Geelong Osteoporosis Study. J Bone Miner Res. 2004;19(1):19–24.

    CAS  PubMed  Google Scholar 

  105. Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provides new insights into osteoporosis. Endocrine. 2014;46(3):397–405.

    CAS  PubMed  Google Scholar 

  106. Minkowitz B, Boskey A, Lane J, Pearlman H, Vigorita V. Effects of propranolol on bone metabolism in the rat. J Orthop Res. 1991;9(6):869–75.

    CAS  PubMed  Google Scholar 

  107. Ushijima KLY, Maekawa T, Ishikawa E, Motosugi Y, Ando H, Tsuruoka S, Fujimura A. Protective effect of amlodipine against osteoporosis in stroke-prone spontaneously hypertensive rats. Eur J Pharmacol. 2010;635:227–30.

    CAS  PubMed  Google Scholar 

  108. Lewallen S, Courtright P. Epidemiology in practice: case-control studies. Community Eye Health. 1998;11(28):57–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  109. Lobo FS, Wagner S, Gross CR, Schommer JC. Addressing the issue of channeling bias in observational studies with propensity scores analysis. Res Social Adm Pharm. 2006;2(1):143–51.

    PubMed  Google Scholar 

  110. Makam AN, Boscardin WJ, Miao Y, Steinman MA. Risk of thiazide-induced metabolic adverse events in older adults. J Am Geriatr Soc. 2014;62(6):1039–45.

    PubMed  PubMed Central  Google Scholar 

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    Authors and Affiliations

    1. Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore

      Hui Ting Ang, Kai Zhen Yap & Zafirah Banu

    2. Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Republic of Singapore

      Ka Keat Lim, Yu Heng Kwan, Julian Thumboo & Truls Ostbye

    3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK

      Pui San Tan

    4. Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549, Republic of Singapore

      Chuen Seng Tan

    5. Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Republic of Singapore

      Warren Fong & Julian Thumboo

    6. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

      Warren Fong

    7. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Republic of Singapore

      Warren Fong & Lian Leng Low

    8. Department of Family Medicine and Continuing Care, Singapore General Hospital, 20 College Road, Singapore, 169856, Republic of Singapore

      Lian Leng Low

    9. SingHealth Duke-NUS Family Medicine Academic Clinical Program, 8 College Road, Singapore, 169857, Republic of Singapore

      Lian Leng Low

    Authors
    1. Hui Ting Ang
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    2. Ka Keat Lim
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    3. Yu Heng Kwan
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    4. Pui San Tan
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    5. Kai Zhen Yap
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    6. Zafirah Banu
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    7. Chuen Seng Tan
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    8. Warren Fong
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    9. Julian Thumboo
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    10. Truls Ostbye
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    11. Lian Leng Low
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    Corresponding author

    Correspondence to Lian Leng Low.

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    Funding

    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.

    Additional information

    Hui Ting Ang and Ka Keat Lim are co-first authors.

    Electronic supplementary material

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    Supplementary material 1 (DOCX 973 kb)

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    Cite this article

    Ang, H.T., Lim, K.K., Kwan, Y.H. et al. A Systematic Review and Meta-Analyses of the Association Between Anti-Hypertensive Classes and the Risk of Falls Among Older Adults. Drugs Aging 35, 625–635 (2018). https://doi.org/10.1007/s40266-018-0561-3

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    • DOI: https://doi.org/10.1007/s40266-018-0561-3

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