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Comment & Response
October 22/29, 2019

Antihypertensive Medication Use in Older Adults at Risk for Hip Fracture—Reply

Author Affiliations
  • 1Marcus Institute for Aging Research at Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
  • 2Duke University School of Medicine, Durham, North Carolina
JAMA. 2019;322(16):1609. doi:10.1001/jama.2019.13954

In Reply Conflicting data exist on the relationship between antihypertensive medications and falls, particularly among patients beyond the eighth decade of life and frail older adults. In a large observational study of Medicare beneficiaries with hypertension (mean age, 80 years), Tinetti et al1 used propensity scores to match patients according to the intensity of antihypertensive therapy. In the primary analysis, exposure to moderate- or high-dose antihypertensive drugs was associated with a 30% to 40% increased risk of injurious falls compared with no antihypertensive drug use. The association between antihypertensive medications and injurious falls was strongest in participants with a previous fall injury.1 In contrast, a systematic review found no association between antihypertensive medications and falls, but most of the studies included used observational designs and did not use propensity scores to minimize bias.2