First BP Prescription Linked to Slight Increase in Fall Risk: Study Shows
Netherlands: A retrospective observational study published in The Lancet Primary Care found that initiating antihypertensive (blood pressure–lowering) medication in primary care may be associated with a small increase in the risk of hospitalization or death related to falls. The findings highlight the importance of careful monitoring, especially during the early phase of treatment initiation in vulnerable patients.
The study, led by Florien S van Royen from the University Medical Centre Utrecht, examined whether this potential risk varies across different patient groups, including sex, ethnicity, and socioeconomic status. Antihypertensive drugs are widely prescribed to reduce cardiovascular risk, but concerns about adverse events such as falls—particularly in older or frail individuals—have persisted.
For this purpose, the researchers conducted a large retrospective cohort analysis using data from the Clinical Practice Research Datalink Aurum database in England. The study included more than 2.6 million adults aged 40 years and older with systolic blood pressure ranging from 130 to 179 mm Hg and no prior use of antihypertensive therapy. Participants were followed for up to 10 years to assess the occurrence of serious fall-related outcomes, defined as hospitalization or death.
The study led to the following findings:
- Nearly 13% of the study population initiated antihypertensive therapy within one year of inclusion.
- Over a median follow-up of seven years, 4.2% of participants experienced hospitalization or death related to falls.
- Fall-related events were more frequent among those receiving antihypertensive treatment (7.1%) compared to untreated individuals (3.8%).
- Antihypertensive use was associated with a modest increase in fall-related risk across the population.
- The association between treatment and falls was similar in men and women, indicating no significant sex-based differences.
- Although relative risk estimates were somewhat higher in Black, South Asian, and mixed ethnic groups, these differences were not considered clinically meaningful overall.
- Socioeconomic status did not significantly influence the association between antihypertensive therapy and fall-related outcomes.
- Only minor variations were observed between the most and least deprived groups.
- The absolute increase in risk remained low across all subgroups.
- The absolute risk difference was small, with no more than 12 additional fall-related events per 10,000 patients annually in any subgroup.
The findings build on prior work from the STRATIFY research group, which reported higher adverse event risks in older and frail individuals after starting antihypertensives. This study expands the evidence by examining underrepresented groups, including ethnic minorities and socioeconomically disadvantaged populations.
Overall, antihypertensive therapy was associated with a slight increase in serious fall risk, but this did not vary meaningfully across demographic or socioeconomic groups. These results suggest treatment decisions should not be altered solely based on these factors.
The researchers noted that the absolute risk remains low and must be balanced against the proven cardiovascular benefits of blood pressure control. However, they acknowledged that residual confounding cannot be fully excluded due to the observational design.
The large real-world study shows a small but consistent increase in fall-related adverse events with antihypertensive use, with no significant differences across subgroups, supporting continued use with appropriate monitoring.
Reference:
Van Royen, F. S., Wang, A., Geersing, G., Koshiaris, C., Swain, S., Banerjee, A., Clegg, A., Payne, R. A., Bellows, B. K., Hobbs, F. D. R., McManus, R., & Sheppard, J. P. (2026). Association between antihypertensive treatment and hospitalisation or death due to falls according to sex, ethnicity, and social deprivation status: An observational cohort study in English primary care electronic health-care records. The Lancet Primary Care, 100150. https://doi.org/10.1016/j.lanprc.2026.100150
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