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Risk of falls with blood pressure drugs

Drugs that reduce high blood pressure can cause drowsiness that causes some people to fall. But the chance of falling, and of injury, may be greater than previously thought, especially for people who have several long-term illnesses.
By Grant Stewart

BMJ Group News

What do we know already?

blood pressure being taken

Having high blood pressure (doctors call it hypertension) increases someone’s chances of having a heart attack or stroke. Medicines called antihypertensives that lower blood pressure can help prevent these happening. But these drugs can cause balance problems and dizziness, leading to falls and injuries.

High blood pressure affects many older people, whose bones tend to be weaker, and in whom a fall injury such as a broken bone can have serious health consequences.

Previous studies have highlighted this side effect of blood pressure drugs. But they only looked at how the drugs affected people with high blood pressure and no other illnesses. People taking medicines for other long-term illnesses or conditions were excluded from these studies so that the researchers could be sure they were only looking at the effects of one kind of drug. Although this makes good sense in one way, it doesn’t really reflect that many older people may take many different medicines to treat several conditions.

The researchers in this study wanted to know how these drugs affected people’s chances of falls in the ‘real world’, where other conditions and other drugs might contribute to someone’s chances of drowsiness or frailty. So the researchers didn’t exclude people who had multiple conditions and who were taking several medicines.

They looked at the medical records of nearly 5,000 people all aged over 70, who all had high blood pressure. The average age of the people in the group was 80. Some of them were taking no medicines to lower their blood pressure, while some were taking a ‘moderate’ amount of blood pressure medication, and others a ‘high’ quantity of blood pressure medication. The researchers looked at what happened to them over the next three years, and at whether there was any link between the number of people taking blood pressure drugs and the number of people who had serious falls.

What does the new study say?

Compared with people not taking blood pressure drugs, those taking the drugs were more likely to have a serious fall. And, compared with research that only looked at people with high blood pressure, the chances of someone falling while taking blood pressure drugs in this study were slightly higher.

Over the three years serious falls happened to:

  • between 7 and 8 in 100 people not taking blood pressure drugs
  • about 10 in 100 people taking moderate amounts of blood pressure drugs, and
  • just over 8 in 100 people taking high doses of blood pressure drugs.


How reliable is the research?

The main problem with this study is also, in a way, its main strength. That is, that it didn’t just look at falls in people whose only health problem was high blood pressure. The reality for many older people is that they will have several long-term illnesses and will be taking several kinds of medicine.

Of course this makes this study’s findings less reliable, as we can’t be sure that it was the blood pressure drugs that caused people to fall. But, as we already know that these drugs can cause falls, this isn’t as important as looking at a more ‘real’ group of people than is usual in studies.

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