Abstract
The use of antihypertensive drugs in the elderly population places patients at an increased risk of adverse drug events in both the inpatient and outpatient setting. The setting of appropriate blood pressure goals and using antihypertensive medications is complex and no consensus exists. Hypertension treatment goals need to be individualized. Well-known trials have described the risks of falls and fall-related injuries in older adults taking antihypertensive medications. The results from these studies may not be directly applicable to the population of frail older patients. In three meta-analyses conducted in 1999, 2009, and 2013, there was no clear statistically significant evidence indicating that antihypertensive medications increase the risk of falls, but the clinician still needs to be aware of the impact of drug therapies and fall-related injuries. Although the adverse relationship between cardiovascular medications and falls and fall-related injuries in older adults is supported by high-quality and well-conducted observational studies, only thiazide diuretics have been singled out. The safe and effective use of cardiovascular medications in physically frail older patients requires deliberate and thoughtful considerations. Managing polypharmacy, performing medication reconciliation and review, and employing deprescribing strategies will result in an appropriate cardiovascular medication regimen while minimizing adverse effects and reducing the risk for falls in older patients.
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Abbreviations
- ACCF:
-
American College of Cardiology Foundation
- ACCORD:
-
Action to Control Cardiovascular Risk in Diabetes
- ACE:
-
Angiotensin-converting enzyme
- ADA:
-
The American Diabetes Association
- AGS:
-
American Geriatrics Society
- ALLHAT:
-
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
- ARB:
-
Angiotensin II receptor blockers
- ASH/ISH:
-
The American Society of Hypertension and The International Society of Hypertension
- BBs:
-
Beta-blockers
- CCBs:
-
Calcium channel blockers
- CHEP:
-
The Canadian Hypertension Education Program
- CI:
-
Confidence interval
- ESH/ESC:
-
The European Society of Hypertension and The European Society of Cardiology
- HR:
-
Hazard ratio
- HYVET:
-
Hypertension in the Very Elderly Trial
- JNC:
-
Joint National Committee
- KDIGO:
-
The Kidney Disease Improving Global Outcomes workgroup
- OR:
-
Odds ratio
- SBP:
-
Systolic blood pressure
- SHEP:
-
Systolic Hypertension in the Elderly Program
- SPRINT:
-
Systolic Blood Pressure Intervention Trial
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Salbu, R.L., Leipzig, R.M., Ko, F.C. (2016). Antihypertensives and Cardiovascular Medications. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_12
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DOI: https://doi.org/10.1007/978-3-319-32304-6_12
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