It has been clear for some time that blood pressure medications can cause falls in older adults, primarily due to lowering blood pressure too far causing lightheadedness (dizziness) or by lowering your pulse (heart rate). However, recent studies have drawn a more specific correlation between blood pressure medications and falls by showing the increase in risk for a hip fracture is highest within the first 45 days after starting the medication. One major study from Canada, involving over 300,000 cases, showed a 43% increase in risk for hip fracture within 45 days. Another study showed about the same correlation. Keep in mind that does not even measure the actual risk of falling, but just the number of hip fractures. Other serious injury or poor outcomes can result from a fall in an older adult so these data are limited in telling us the entire story. Regardless, what we can take from this and other recent information is:
- When considering starting a blood pressure medication, first confirm you have high blood pressure. Do not allow a prescriber to start a medication based on one or two office visit blood pressure readings. It is not uncommon to have a falsely elevated blood pressure when in this physicians office, which is referred to as “white coat hypertension”. Confirm your blood pressure readings over a period of time, which can be over a week at various times of day by purchasing a home blood pressure kit and take your blood pressure by following the instructions: Do not talk during the measurement; use the correct cuff size; do not exercise or walk briskly within 5 minutes just prior to taking your blood pressure; and follow the proper technique of cuff placement as per the blood pressure monitor manual. Other options are to seek community resources for having your blood pressure checked, but again, don’t rush in and get your blood pressure measured. Walk in, relax for five minutes, and then get it measured.
- When considering starting a blood pressure medication, first ask your doctor if it’s the lowest dose to begin with. Many prescribers do NOT pay attention to what is a more appropriate dose in the older adult population and start on doses that are too high.
- If you need a blood pressure medication make sure you ask the physician about proper blood pressure targets to shoot for. In older adults the old “120 over 80” or “the lower the better” does not hold true and is actually associated with harm. For most people without other chronic conditions requiring a lower blood pressure, targeting 130-140/80-90 is more than reasonable based on standards.
- If you have any change in how you feel or function, such as lightheadedness, dizziness or imbalance, contact your physician as soon as possible.