Have you had any concerns about an older person falling, or being at risk for a broken hip?
A new clinical research study relevant to millions of older adults was just featured in the news.
The study, completed by a team of geriatrics researchers at Yale, found that in older adults aged 70 or older, taking blood pressure medication was linked to a higher risk of serious falls. (Serious falls as in, falls that caused an ER visit for a fracture, a dislocated joint, or a brain bleed. Serious stuff indeed!)
So, if the person you care for has a diagnosis of hypertension, and if you’ve had any concerns regarding falls or near-falls, these study results should be of interest to you.
In this post, I’ll review the key results of this study. Then I’ll tell you what I think are the most important practical take-aways for family caregivers.
This post will also include some practical tips to help you minimize the risk of your loved one experiencing a serious fall.
Key results of the high blood pressure medications and falls study
One of the many good things about the study is that it used the Medicare records of a “real-world” group of 4961 people aged 70 or older. (This is important because many clinical trials of BP medication are done with patients recruited specifically for the study; there are advantages to this but it means that often patients in clinical trials are healthier than the aging adults that you and I are caring for.)
To be included in this “real-world” study, the patients had to have a diagosis of high blood pressure, they had to be living at home or in assisted-living, and they had to be in Medicare fee-for-service (no Medicare Advantage patients).
The researchers then examined three years worth of these patients’ Medicare records. Here’s what they found:
- Overall, 9% of these older people experienced a serious fall injury.
- When people were classified based on how much BP medication they were taking, the percentages of aging adults having a serious fall within 3 years were:
- No medication: 7.5%
- Moderate-intensity BP medication: 9.8%
- High-intensity BP medication: 8.2%
Next the researchers used some statistical adjustments, to compare older adults with similar levels of illness burden. (It’s important to do this adjustment, because otherwise it could be that some people have no BP medication because they are so sick and frail that doctors have stopped their medications.) In this adjusted group, the percentages of older adults having a serious fall over 3 years were:
- No medication: 7.1%
- Moderate-intensity BP medication: 8.6%
- High-intensity BP medication: 8.5%
The researchers also found that in those people who’d had a serious fall injury within the previous year, being on BP medication was linked to an especially high chance of another serious fall.
What you should take away from this study
I consider this study very important, because most clinical research focuses on benefits of medication, rather than studying the potential harms and downsides of medication. It’s probably not a coincidence that the main author is a geriatrician; we tend to feel that a little goes a long way when it comes to medications in aging adults!
Key take-aways for family caregivers:
- Serious falls are a fair possibility in all older adults aged 70+. Over 3 years, 9% of these Medicare patients had a fall involving a fracture, a dislocation, or a brain bleed. It’s probably reasonable for you to assume that your loved one has at least a roughly 10% chance of a serious fall within a few years. This risk is higher if your loved one has already had a serious fall.
- Consider learning practical approaches to reducing fall risk in your loved one. Along with learning to be careful with medications, there is lots more that you can do! Visit our fall prevention topic page to see all our articles on this topic.
- Consider a plan or system to call for help in the event of a fall. This is especially important for those independent older adults who live alone! Last year I saw a patient who lay at home with a broken hip for 2 days before he was found 🙁
- Home sensors and/or a personal emergency response system can help alert a care circle when an older person falls.
- Being on blood pressure (BP) medication raises the risk of a serious fall. This doesn’t mean your loved one shouldn’t take any medication for high BP. But it does mean that you should be thoughtful about weighing the benefits and the risks, and you probably want to aim for the lowest doses possible. In my experience, regular doctors tend to not think of the risks of BP medications in aging adults. So here are some specific things YOU can do:
- Be careful if your loved one’s BP is often below the new recommended target of 150/90. Read “What the New Blood Pressure Guidelines Mean for Older Adults” for more info.
- Ask the doctors to help you understand how much benefit to expect from the BP treatment. Note that often the expected chance of benefit (e.g. avoiding a stroke or heart attack) is about the same as the risk of harm that was found in this research study.
- Seniors who’ve had a previous serious fall are at extra high risk. Be extra careful about blood pressure and over-treatment if your loved one has already had a serious fall. These are the older adults for whom it’s most important to make sure that they aren’t on more medication than is absolutely necessary.
- Know that in general, the most benefit from treating high blood pressure in seniors comes from getting a systolic blood pressure (SBP; that’s the top number that a monitor reports) from 170 or higher, down to 140s-150s.
- Once elderly people are treated to a SBP below 140, the chance of harm can easily become bigger than the chance of benefit.
- Get a home blood pressure machine if you’re concerned about falls and your loved one is on medication. Don’t just leave it to the doctors to monitor things and take action. When properly done, home BP measurements can be more accurate than occasional office measurements, and can lead to better care. For more on this topic, here are some posts I wrote last fall:
Do you have any questions about how to reduce the chance of falls and injuries in aging adults?
Please post them below in the comments section.
Walter Buddlestone says
This 2014 study shows association (not causation) with little controls for other causes of falls. Wish I could have reviewed it before publication. The 2015 study published by Hypertension refutes most of it. I consider this type of thing click bait.
Nicole Didyk, MD says
Hi Walter. You’re correct that there are limitations to the study by Dr. Tinetti discussed in this article, but the relationship of falls and antihypertensives is somewhat controversial. For example, this analysis of the ALLHAT data did seem to demonstrate an increase in fall risk for use of amlodipine at 1 year.
I’m not sure which trial you’re referring to from 2015 so please feel free to share it.
I disagree with the clickbait comment, but thanks for checking out the article!
I am 57!! I fell and broke my right hip and the top of my femur in January!! Metal plate and screws!! I’m Feb. I feel and broke my left femur, I got a rod put in my femur!! Neither falls where hard falls, mote like tripping over something, the first break I was bringing my dog inside, I hit a small hole and fell!! I never felt pain like that in my life!! In February I got up to go to the bathroom (was on pain pills) I didn’t have my grippy socks on, my right leg already was getting stronger so I didn’t use my walker. As soon as I got off our throw rug and I hit the hardwood floor I went down again!! Broke my left Femur, to low to hurt my hip, the pain again was the worst I have ever been through!! I take blood thinner, 2 different meds for high blood pressure and an antidepressant, but now, my blood pressure is going low!! I don’t know what to do!!!
Nicole Didyk, MD says
I’m so sorry to hear about your falls and fractures. Thanks for sharing your story though, because you list many issues that can contribute to falls. A fall is usually due to more than one factor, as I describe here.
This is actually good news, because it means there are many avenues that can be explored and adjusted to prevent future falls. Dr. Kernisan has a good article about that, which you can read here. I find that medication review and a consultation with an Occupational Therapist are 2 very important steps in falls prevention (and it’s not just my opinion – the scientific evidence backs that up too!).
Finally, in any of my patients who are falling, I review bone health, and consider dietary, lifestyle and medication interventions to strengthen bone and reduce fracture risk.
My mother will turn 86 soon, and has heart disease (HBP/mitral valve prolapse), and is on 3-4 heart medicines (Irbesartan, Carvidilol, Amlodipine, and sometimes hctz). She also takes a statin. She received an E clip in her mitral valve to assist it in closing 10 years ago. It has now failed, and it cannot be removed because of the nature of how it is placed (like an angioplasty). She was rejected for open heart surgery to repair it 2 years ago. I know these medicines make her feel bad, and wondered if we should talk to her cardiologist about discontinuing them?
Leslie Kernisan, MD MPH says
Yes, if your mother’s medications are affecting her quality of life, then I would definitely recommend bringing this up and discussing this with her cardiologist.
What is best is to start by asking to review her prognosis and her goals of care. By prognosis, I mean how her heart and her health are doing, and what the doctors think she should expect over the next few years. As part of this, be sure to ask how her medications are likely to change her risk of decline. Once you and your mother understand her heart condition, you’ll be in a position to discuss what should be the priorities, when it comes to her medical care. The default in medicine is to always prioritize reducing the risk of death, but that’s not always the best priority for some older adults, who may be more interested in maximizing quality of life or their ability to walk and be functional.
For more on discussing what matter, try browsing the site PatientPrioritiesCare.org. Good luck!
Julie G says
Hello. Hope you can help. My mother’s GP took her off BP meds 2 years ago after 20 years on them because of the risks of falls and leg swelling. He checked her BP after 6 months but not thereafter. Mum died a few months ago of an intracranial haemorrhage. I decided to question the fact that my mother’s BP wasn’t monitored for 18 months before she died but at first the GP wasn’t forthcoming. I arranged to meet him face to face and received an apology and an acknowledgment that she should have had more regular monitoring. I feel terrible that I didn’t know she might be at risk and could so easily have bought a home cuff. I just presumed if they were removing a drug she wouldn’t be in danger. I know she may have still died of a stroke whilst on BP treatment but she suffered at the end. I feel I wasn’t vigilant enough.
Leslie Kernisan, MD MPH says
I’m very sorry to hear of your loss. It sounds like you might be considering yourself responsible for what happened regarding your mother’s health and her death.
To even comment on whether it’s likely that your mother’s lack of BP treatment was a major factor leading to her death, I would have to know many more things about her: her past medical history, her age and condition when the BP meds were stopped, and what her BP was during the 18 months afterwards. (Presumably, she had it occasionally checked after she stopped the BP meds, because checking BP is done at most medical visits.)
It’s possible that the GP really erred. It’s also possible that instead of completing stopping the BP meds, it may have been reasonable to just reduce them and be less aggressive with BP control.
If you feel you really need to understand what happened medically, in order to process your mother’s death and your concern that you didn’t do enough, you would need to obtain her records and consult with a clinician who could review her case. This may or may not help you feel better.
Me, I would say that no matter what happened or didn’t happen, the fact that you are thinking about this suggests that you loved her very much and tried hard to do right by her. Whatever you did was very important and, in the ways that matter most, was surely enough. Don’t hold yourself to the impossible standard of having obtained optimal healthcare for her. Almost nobody is able to do it, and it’s not a reasonable standard to hold yourself too.
Instead, I would encourage you to mourn her and also to seek some counseling to help you work through the loss and any related guilt. 99% of guilt felt by family members is unwarranted, and is really a result of caring a lot and having unreasonably high expectations of oneself.
Please take care of yourself and I hope you find some relief from your distress soon.
Bright morgan says
Dr, my name is Bright Morgan. Am 32 years old. My doctor placed me on BP medication named (AMLODIPINE and NORMORETIC once daily for two weeks now. Am already 10days gone at it. My BP was 180/130 when I started taking the two drugs.
This morning, I woke up to visit my convenience about 3:38 am. I sat on the closet and my poo was a bit purged and my lower abdomen started aching me and I felt like “throwing up”. So I decided to get up from the water closet and clean myself, next thing I fell flat and hit my head on the tiles. I got up immediately and was weak. I laid down on my bed and later went off to work.
Now at the office, am feeling cold on my head. That spot I hit on the floor tiles. What could be the reason? Am feeling slight sensation on my skul also.
Leslie Kernisan, MD MPH says
If you’re feeling unwell and weak enough to be falling, you should contact a doctor as soon as you can, to describe your symptoms and figure out whether you need to be seen urgently. Any number of potentially serious health conditions can cause such symptoms.
Otherwise, you say what your BP was before you started medication but you don’t say what it is now. It is possible for people to be overtreated with BP medication and then feel lightheaded. So I would recommend asking your doctor what your goal BP should be, and asking to have it rechecked now that you are on medication. Doctors sometimes tell people to come back in several weeks or months for a follow-up BP check, but if you are feeling unwell, it’s a good idea to be checked sooner.
Steve Allison says
I had cardiac surgery in 2004 and have been on 2X atenolol 50mg and one 20mg lisinopril for many years.
Checking bp a few times weekly, about 6-8 months ago, I noticed my bp was trending downward, causing me to fall below 100/~75 and feeling tired more than usual.
Without notifying my VA doctor, I started reducing the atenolol while watching bp daily and am now taking 25mg only once but leaving the lisinopril at 20mg.
My bp is still often at approx. 100/~72.
I am a 76 y/o male, less active than many due to my lousy balance and legs that are mostly numb.
I don’t understand why my bp is trending downward instead of up as I would have expected.
Leslie Kernisan, MD MPH says
One’s body and metabolism can change over years, so it’s not surprising that your dose of BP meds might have to change at some point.
It does sound a bit odd that you aren’t seeing your BP get higher, despite a lower dose of medication.
I would encourage you to bring up your concerns and observations with your doctor. There may be other issues going on, that are causing you to either have low BP or perhaps that are causing your medications to have a stronger effect than anticipated. For instance, atenolol is metabolized by the kidneys, so the drug can last longer in one’s system if kidney function declines.
Don’t forget to always record pulse along with BP; doctors need to see a heart rate along with BP, in order to figure out a reasonable next step for evaluating your BP issues. Good luck!
Thank you for this discussion. My mum is 75 year old. She has a knee replacement recently and since then her BP is became lower . SHE IS IN MEDICATION for BP and BP reach to 130/56 . So the Dr advice her to stop take the medicine and then increased a bit in these ranges 130/60 145/62. I do watch her diet for a while and our food has no salt and we eat healthy green meals. Is it advisable to stop BP medication? Two days ago the Dr stoped her med. What do you think. I am worried about her even though gently she is in good health. She do have low blood counts (8) after the operation. Is this has any thing to do with lower blood pressure. She does take others medI cation to increase blood counts.
Leslie Kernisan, MD MPH says
If you haven’t already read it, you might find this article helpful: 6 Steps to Better High Blood Pressure Treatment for Older Adults.
I can’t say what is advisable for your mom; mostly what I do through this site is share better practices in senior healthcare and help people identify good questions to ask their doctors.
I would suggest you ask yoru doctor why he wanted to stop her BP medication, also what target BP does he think is right for mother and why.
Several expert societies have said a target systolic blood pressure (“SBP”; that’s the top number of the BP reading) of less than 150 is reasonable for many older adults. So if her BP is 130s-140s, that would meet that goal. However some older adults have other medical conditions that mean they are likely to benefit from a lower BP. This is why you should talk to the doctor and find out what his/her reasoning is.
Re her blood count, if “8” refers to a hemoglobin level of 8, that’s actually pretty low and can cause some weakness or dizziness. So that might be part of why the doctor wanted to stop the BP meds.
In short: talk to the doctor, share your concerns and questions, and make sure you understand what benefits and risks the doctor thinks your mom will experience from this course of action. Good luck!
Thank you for your helpful web page and taking the time to answer questions.
My 85 year old Mum and I skyped last night and she admitted she has be having episodes of feeling other-worldly, like she is out of control and her legs run away independently while she feels in a daze. She likens it to the cartoon character Road-runner taking off. The last episode of three she has had over the last two weeks had her career into a wall which has caused a big egg shaped lump on her head and many bruises.
She ended up in hospital two nights where she had loads of tests. They say she is a very fit 85 year old (she has walked everyday for 1.5 miles for years).
She was advised this may be due to her blood pressure tablets and has stop taking that particular medication. I have read the other questions and falling seems to be a common side effect. I am just curious about the delirious state Mum has before an episode. It only lasts about ten seconds but it is very frightening.
Leslie Kernisan, MD MPH says
Thank you, I’m glad you find the site helpful.
People do get lightheaded when they stand or when their blood pressure otherwise drops. There are also other problems that can cause such symptoms, but sounds like she had a thorough workup. Hopefully the change in medication will improve her symptoms.
I would recommend that your mom keep a journal if possible, recording when she has these symptoms. If it’s related to blood pressure medication, it should come on with standing or a change in body position.
For more on how your mom can work with her doctors on finding the right blood pressure treatment, see 6 Steps to Better High Blood Pressure Treatment for Older Adults. Good luck!
Kurt Kronfuss says
I live in Florida and my 88 year old mother lives in Minnesota. My nearest siblings live 20 miles from her and she has 2 neighbors that check on her most every day. She gets around well an does most daily things herself without to much problem.
About ten months ago she was experiencing severe pain in the hip area and went to her Dr. When they checked her BP she was in this pain and also had anxiety and aggravation caused by a well meaning person attending her checkup. She was immediately but on BP medicine. Her memory and mindset soon took a turn for the worse.
This past weekend I was able to visit her and her mindset was leaning toward giving up. I reminded her of a time in her 50’s when a Dr. put her on BP meds and she had the same memory and cognitive function problems, she quit the meds back then and lived with (high) BP, as far as I know, until this latest incident.
While there I dug out her BP cuff and took her BP one morning before she had taken that days BP pill, she was a bit anxious and her BP was 178/94. About an hour later, after I calmed her but before she took her BP pill, I got a reading of 148/88.
She knows this medication is causing problems and expressed a desire to get off of them. I cut her pills in half for a week, and in quarters for the following week-along with written instructions she is capable of following, to ween her off of them. I also instructed her to take a daily BP reading and I am calling her daily to ensure BP does not get out of hand, and to keep her hope up; as she falsely claimed that I saved her life with my visit.
I need to know if there are any problems with what I did, and how do I convince the siblings that desire(d) her to be on this medication while her BP was not being regularly checked, and with them assuming she needs this medication, that she may not need it, especially at her age? I think it is doing more harm than good. Any advice or help is greatly appreciated.
Leslie Kernisan, MD MPH says
Re how to figure out what BP to aim for, see this newer article: 6 Steps to Better High Blood Pressure Treatment for Older Adults. This article summarizes the recent research on what BP to aim for in older adults, and should help you identify the issues to bring up with your siblings and your mother’s doctor.
Otherwise, you mention that it’s been 10 months since your mother’s memory and mindset took a turn for the worse. It’s possible that this was related to the BP medication changes. But at her age, there are many other things that can affect memory, mindset, and/or health. So I would encourage you and your family to not assume that it’s the BP meds, because it’s quite possible that there is something else. For instance usually I would check into the possibility of several other things, including side-effects from other medications, depression, untreated pain, thyroid problems, electrolyte imbalances, and so forth.
Kurt Kronfuss says
My mother had a fall as well after she went on blood pressure medication, but I’d never thought to link these things. I’m so glad I found this article while just looking up high blood pressure articles for myself. Very interesting indeed.
I’m afraid I’m going to have to go on medication as well, and I hope I don’t have the same problems. I’m relatively young so I’m hoping that will be a saving grace.
I did recently go out and get an Omron series 10, and that’s proven to be a great little tool. I’ve been obsessively checking every day and I think that’s actually helping me be way more aware and therefore vigilant about my blood pressure. I’d definitely recommend picking one up.
Leslie Kernisan, MD MPH says
Checking BP at home has been shown to be more accurate than the usual office-based measurements. I think the goal should be less about vigilance and more about getting good measurements periodically, especially if medication changes are involved.
Experts recommend checking twice a day for a week, if medication is being considered or has recently been changed. After that, it’s probably not necessary to check every day for most people. I have more information on this here:
6 Steps to Better High Blood Pressure Treatment for Older Adults