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Commentary
Adverse effects of antihypertensives in frail older people
  1. Joanna Owens1,
  2. Teck K Khong2
  1. 1Freelance Science Writer and Editor, Leicester, UK
  2. 2Clinical Pharmacology, St George's University of London, London, UK
  1. Correspondence to Dr Teck K Khong; tkhong{at}sgul.ac.uk

https://doi.org/10.1136/dtb.2024.000058

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    Key learning points

    • While treatment of elevated blood pressure (BP) in the elderly has been shown to reduce morbidity and mortality, some studies have suggested that antihypertensives may be associated with adverse events such as falls, fractures and acute kidney injury (AKI).

    • Frail older people with multimorbidity are likely to be at increased risk of adverse events associated with antihypertensive agents.

    • A self-controlled case series of frail older people reported an increase in the risk of AKI and falls on starting treatments commonly used in the management of hypertension.

    • Patients in this study generally had well-controlled BP levels and indications for antihypertensive medications were unconfirmed and could have been prescribed for cardiovascular conditions other than hypertension.

    • Prescribers should follow recommendations to use clinical judgement for those with frailty or multimorbidity when initiating antihypertension medication for people aged >80 years with hypertension if their clinical BP is >150/90 mm Hg.

    Summary

    This UK primary care study found that in older people with complex health needs, treatment with antihypertensive medicines was associated with an increased risk of acute kidney injury (AKI) and a short-term increased risk of falls that was highest during the first 30 days of treatment.1 However, medicines that are used to treat hypertension are commonly used for a variety of conditions and in this study specific indications for their use or doses prescribed were not reported. Patients in the study had median blood pressure (BP) of around 135/76 mm Hg, a level at which treatment of hypertension would not conventionally be initiated.

    Study details

    This self-controlled case series used data from the UK Clinical Practice Research Datalink (CRPD) to examine the effect of antihypertensive medication on older people with complex health needs.1 The study population included people aged >65 years at the start of January 2010 who had complex health needs (CHNs), based on …

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    Footnotes

    • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

    • Provenance and peer review Commissioned; internally peer reviewed.