Study finds no association between BP drugs and falls
UK: There is no association between antihypertensive treatment and falls, suggests a recent review in the journal BMJ. The researchers, however, did find an evidence of association between blood pressure drugs and mild (hypotension, hyperkalaemia) and severe adverse events (syncope, acute kidney injury).
The findings could be useful to inform shared decision making between doctors and patients about initiation and continuation of antihypertensive treatment, particularly in patients at high risk of harm because of poor renal function or previous adverse events.
Ali Albasri, University of Oxford, Oxford, UK, and colleagues aimed to examine the association between antihypertensive treatment and specific adverse events in this systematic review and meta-analysis.
For the purpose, the researchers searched online databases from inception until 14 April 2020. It included randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets. Studies were required to have at least 650 patient years of follow-up.
Of 15 023 articles screened for inclusion, 58 randomised controlled trials were identified, including 280 638 participants followed up for a median of 3 (interquartile range 2-4) years.
Key findings of the study include:
- Most of the trials (n=40, 69%) had a low risk of bias.
- Among seven trials reporting data for falls, no evidence was found of an association with antihypertensive treatment (summary risk ratio 1.05).
- Antihypertensives were associated with an increased risk of acute kidney injury (1.18, n=15), hyperkalaemia (1.89, n=26), hypotension (1.97, n=35), and syncope (1.28, n=16).
- The heterogeneity between studies assessing acute kidney injury and hyperkalaemia events was reduced when focusing on drugs that affect the renin angiotensin-aldosterone system.
- Results were robust to sensitivity analyses focusing on adverse events leading to withdrawal from each trial.
- Antihypertensive treatment was associated with a reduced risk of all cause mortality, cardiovascular death, and stroke, but not of myocardial infarction.
"This review found no evidence of an association between antihypertensive treatment and falls (primary outcome) or fractures but did show a variation in the association between antihypertensive treatment and mild (eg, hypotension without falls) and more severe (eg, acute kidney injury, syncope) adverse events. Some effects were found to be specific to the drug class used," wrote the authors.
"In patients at high risk of drug harms because of previous adverse events or poor renal function, these data should be used to inform shared decision making between doctors and patients around initiation and continuation of antihypertensive treatment," they concluded.
The study titled, "Association between antihypertensive treatment and adverse events: systematic review and meta-analysis," is published in the journal BMJ.
