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Comment & Response
November 2014

Risks and Benefits of Antihypertensive Medications in Older Adults—Reply

Author Affiliations
  • 1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2014;174(11):1873-1874. doi:10.1001/jamainternmed.2014.4520

In Reply We appreciate the opportunity to respond to the comments by Margolis et al regarding our article.1 The low rates of serious injuries such as fractures observed in several randomized clinical trials (RCTs) of older adults all included samples that are healthier than average clinical populations of older adults. The authors correctly note that the purpose of our study was to determine the risk of experiencing serious fall injuries among representative samples of older adults. The estimate for the annual fall injury rate or incidence proportion in our sample is 4.3%, based on the total number of participants experiencing at least 1 event (446) and the mean time to first serious fall injury (772 days), not 1.5% to 2.0% as the reviewers suggested. Therefore, our annual serious fall injury rate is 3.3 times higher than the 1.3% annual rate observed in the Hypertension in the Very Elderly Trial (HYVET) population.2 The rate would be higher if we accounted for recurrent serious fall injuries (446 participants experienced 540 serious injury events).

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