“Do you avoid a heart attack by using drugs associated with an almost equal risk of breaking a hip or injuring your brain?” That’s the question being asked by Yale researchers in a study of elderly adults who take anti-hypertensive drugs.
Clinical trials, typically comprised of fairly healthy individuals, have shown that the current drugs prescribed for hypertension reduce heart failure, heart attacks and stroke with very few side effects. This has led physicians and patients to assume it is safe for elderly adults to take one or more of the diuretics, beta blockers, calcium channel blockers, the renin-angiotensin system blockers prescribed for people with hypertension, or high blood pressure. The problem is that a study of 5,000 Medicare beneficiaries found that 85% of those individuals were taking one or more of the drugs. Some took three or more.
“The prevailing notion is that these medications are safe, with very few adverse effects,” said Dr. Mary Tinetti, chief of geriatrics at the Yale School of Medicine, and lead author of the study.” Dr. Tinetti and her team are looking at the use of anti-hypertensive drug in senior citizens (average age is 80) over a three-year period. They found, “The risk of serious fall injuries — fractured bones, brain injuries or dislocated joints — was significantly higher among those who took anti-hypertensives than among those who didn’t.” (NY Times, 4/16/14)
These medications reduce blood pressure to the degree that patients may report feeling lightheaded or dizzy upon standing. The risk of falling increases with these medications, which can lead to serious complications for some elderly patients.
The Yale study brings up a number of questions having to do with risk assessment, defining dangerous blood pressure levels, and making a determination about quality of life. Is it better to decrease blood pressure medications for frail patients who have an increased fall risk? Or is the risk of heart attack too great without taking such a medication?
Older adults, their caregivers, and family members should ask the doctor to reassess usage of blood pressure medications. Is the patient taking too many medications? Is the hypertension severe enough to outweigh the potential for a serious fall? Dr. Tinetti stated that it is up to the patient (and their caregivers) to approach the topic with his or her doctor. Reliable information and education is the first step.
It is important to review medications on an annual basis, maybe more. Elderly patients should ask questions of their doctors and should expect to be informed about all medications—what they are being prescribed to treat, side effects, medical necessity, and possible risks. If you have an elderly family member, you or a designated advocate should make sure these vital conversations take place.