Falls are a rising public health problem, but treatment of high blood pressure in elderly women does not appear to be one of the contributing causes.
New national research, led by Dr. Karen Margolis of the HealthPartners Institute in Bloomington, defied conventional medical wisdom by finding that elderly women treated for hypertension actually fell less than a comparison group of women who did not have hypertension.
Doctors have hedged on prescribing hypertensive medications for elderly women because of concerns that the drugs could cause swoons in blood pressure that would in turn cause patients to become lightheaded and collapse.
Underlying their concerns is an increase in the rate of fall-related deaths, especially in Minnesota. The state had the third highest age-adjusted rate of fall deaths among the elderly in 2016, according to the Centers for Disease Control and Prevention. Doctors felt justified in trying to prevent falls by withholding medication that could otherwise reduce their patients’ risks of hypertension-related stroke, heart attack and kidney disease, Margolis said.
These latest findings should prompt doctors to reconsider that trade-off, she said. “With this information, we can more confidently say that treating blood pressure to recommended levels in older women, which significantly reduces their chance of having a stroke, is better than not treating it.”
The study of nearly 6,000 women in several states did find weak evidence that women with lower diastolic blood pressures (a reading of 69 or lower in the denominator side of a standard blood pressure measurement), or who took certain antihypertensive medications called beta blockers, were at slightly elevated risk of falls. But overall, drug treatment of hypertension did not elevate fall risk.
The pessimistic reaction to the findings is that doctors might have lost a strategy to reduce falls. Minnesota’s rate of fatal falls among the elderly has doubled in the past 15 years as the state’s population has aged. Only Vermont and Wisconsin had higher age-adjusted rates in 2016.
Margolis said other studies have found fall risks in the first two weeks of taking new blood pressure medications. So she said doctors should still be wary during that time period.
The study, published in the Journal of the American Geriatrics Society, found that falls were less likely in women treated for hypertension compared to women with no hypertension at all.
“Maybe those women are getting more medical care,” Margolis said. “If you have high blood pressure and you’re going to see the doctor regularly, then maybe you are doing other things” that boost health and prevent falls.