Author Affiliations: School of Medicine (Dr Lai) and Graduate Institute of Integrated Medicine (Dr Liao), China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung (Dr Lai); and Department of Internal Medicine, Taichung Tzu Chi General Hospital, and Department of Health Care Administration, Central Taiwan University of Science and Technology, Taichung (Dr Liao).
We read with great interest the recent article by Butt et al,1 reporting that hypertensive older people who used an antihypertensive drug during the first 45 days of treatment could have a 1.43-fold–increased risk of hip fracture (incidence rate ratio, 1.43; 95% CI, 1.19-1.72).1 The authors also explained the mechanism by which orthostatic hypotension caused by antihypertensive drug use would increase the risk of falls and even lead to hip fracture. Likewise, our case-control study analyzing the Taiwan National Health Insurance database also showed that polypharmacy could correlate with increased risk of hip fracture in older people.2 Moreover, extensive evidence has shown that age-related pharmacokinetic and pharmacodynamic changes, polypharmacy, and comorbidities put older people at higher risk for adverse drug reactions and even worse outcomes.2- 5 Therefore, regarding the use of antihypertensive drugs during the initial period, the study by Butt et al1 highlights the importance of the key principle of prescribing for older people: “start low and go slow.”
Lai S, Liao K. Risk of Hip Fracture and Antihypertensive Drugs in Older People. JAMA Intern Med. 2013;173(10):934-935. doi:10.1001/jamainternmed.2013.386