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31/10/2017

Association between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-analysis.


American Journal of Hypertension - DOI: https://doi.org/10.1093/ajh/hpx189


Abstract

Background: Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults.

Methods: DATA SOURCES Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE and MEDLINE databases from 1.1.2007 to 1.6.2017. STUDY SELECTION Research studies of cohort, case-control, case-crossover, cross-sectional or RCT design examining association between antihypertensives and falls in people older than 60 years were evaluated. DATA SYNTHESIS 29 studies (N=1,234,667 participants) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).1 PRISMA2 and MOOSE3 guidelines were used for abstracting data and random-effects inverse-variance (REIV) meta-analysis was conducted on 26 articles examining chronic antihypertensives use, with odds ratios and hazard ratios analysed separately. Time-risk analysis was performed on five articles examining acute use of antihypertensives. OUTCOMES Pooled odds ratios (OR) and hazards ratios (HR) were calculated to determine the association between chronic antihypertensives use and falls. For time-risk analysis, OR was plotted with respect to number of days since antihypertensives commencement, change or dose increase.

Results: There was no significant association between risk of falling and chronic antihypertensive medication use (OR=0.97, 95%CI 0.93-1.01, I2=64.1%, P=0.000; and HR=0.96, 95%CI 0.92-1.00, I2=0.0%, P=0.706). The time-risk analysis demonstrated a significantly elevated risk of falling 0-24 hours after antihypertensives initiation, change or dose increase. When diuretics were used, the risk remained significantly elevated till day 21.

Conclusions: There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.

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Última atualização: 15/12/2017