Hypertension Treatment and Control and Risk of Falls in Older Women

Karen L. Margolis, David M. Buchner, Michael J. LaMonte, Yuzheng Zhang, Chongzhi Di, Eileen Rillamas-Sun, Julie Hunt, Farha Ikramuddin, Wenjun Li, Steve Marshall, Dori Rosenberg, Marcia L. Stefanick, Robert Wallace, Andrea Z. LaCroix

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

BACKGROUND/OBJECTIVES: A lower risk of falls is commonly cited as a reason to treat hypertension conservatively in older individuals. We examined the effect of hypertension treatment and control status and measured blood pressure (BP) level on the risk of falls in older women. DESIGN/SETTING: Prospective cohort study. PARTICIPANTS: A total of 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) enrolled in the Women's Health Initiative and Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS: BP was measured by trained nurses, and hypertension treatment was assessed by medication inventory. Participants mailed in monthly calendars to self-report falls for 1 year. RESULTS: Overall, 70% of women had hypertension at baseline (53% treated and controlled, 12% treated and uncontrolled, 5% untreated). There were 2582 women (43%) who reported falls in the 1 year of surveillance. Compared with nonhypertensive women, when adjusted for fall risk factors and lower limb physical function, the incidence rate ratio (IRR) for falls was 0.82 (confidence interval [CI] = 0.74-0.92) in women with treated controlled hypertension (p =.0008) and 0.73 (CI = 0.62-0.87) in women with treated uncontrolled hypertension (p =.0004). Neither measured systolic nor diastolic BP was associated with falls in the overall cohort. In women treated with antihypertensive medication, higher diastolic BP was associated with a lower risk of falls in a model adjusted for fall risk factors (IRR = 0.993 per mm Hg; 95% CI = 0.987-1.000; p =.04). The only class of antihypertensive medication associated with an increased risk of falls compared with all other types of antihypertensive drugs was β-blockers. CONCLUSION: Women in this long-term research study with treated hypertension had a lower risk of falls compared with nonhypertensive women. Diastolic BP (but not systolic BP) is weakly associated with fall risk in women on antihypertensive treatment (<1% decrease in risk per mm Hg increase). J Am Geriatr Soc, 2019. J Am Geriatr Soc 67:726–733, 2019.

Original languageEnglish (US)
Pages (from-to)726-733
Number of pages8
JournalJournal of the American Geriatrics Society
Volume67
Issue number4
DOIs
StatePublished - Apr 2019

Bibliographical note

Funding Information:
Funding Information: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN 268201600001C, HHSN268201600002C, HHSN2682016 00003C, and HHSN268201600004C. This work was additionally supported by the National Heart, Lung and Blood Institute (grant R01HL105065).

Funding Information:
WHI Program Office (National Heart, Lung, and Blood Institute, Bethesda, MD): Jacques Rossouw, Shari Ludlam, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical Coordinating Center (Fred Hutchinson Cancer Research Center, Seattle, WA): Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg. Investigators and Academic Centers: Brigham and Women's Hospital, Harvard Medical School, Boston, MA: JoAnn E. Manson; MedStar Health Research Institute/Howard University, Washington, DC: Barbara V. Howard; Stanford Prevention Research Center, Stanford, CA: Marcia L. Stefanick; The Ohio State University, Columbus, OH: Rebecca Jackson; University of Arizona, Tucson/Phoenix, AZ: Cynthia A. Thomson; University at Buffalo, Buffalo, NY: Jean Wactawski-Wende; University of Florida, Gainesville/Jacksonville, FL: Marian Limacher; University of Iowa, Iowa City/Davenport, IA: Jennifer Robinson; University of Pittsburgh, Pittsburgh, PA: Lewis Kuller; Wake Forest University School of Medicine, Winston-Salem, NC: Sally Shumaker; University of Nevada, Reno, NV: Robert Brunner; University of Minnesota, Minneapolis, MN: Karen L. Margolis. Women's Health Initiative Memory Study (Wake Forest University School of Medicine, Winston-Salem, NC): Mark Espeland. For a list of all the investigators who have contributed to WHI science, please visit https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator?%20Long%20List.pdf. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. This work was additionally supported by the National Heart, Lung and Blood Institute (grant R01HL105065). The authors have no conflicts of interest to disclose. Interpreting the data and approved the final version: All authors. Conception/Design, drafting the manuscript: Margolis. Conception/Design, critical revision of the manuscript: Buchner and LaCroix. Critical revision of the manuscript: LaMonte, Hunt, Ikramuddin, Li, Marshall, Rosenberg, Stefanick, and Wallace. Analysis of data, critical revision of the manuscript: Zhang, Di, and Rillamas-Sun. The sponsor had no role in the design, methods, subject recruitment, data collections, analysis and preparation of this article.

Publisher Copyright:
© 2019 The American Geriatrics Society

Keywords

  • blood pressure
  • cohort study
  • falls
  • hypertension
  • older adults

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