Blood Pressure Management and Falls in Nursing Home Residents—A Matter of Balance

Canales and Shorr discuss the study by Dave et al. on the association between the initiation of a new antihypertensive agent and the incidence of fall-related fractures in residents at Veterans Health Administration (VHA) nursing homes or community living centers. The study found that residents who received a new antihypertensive agent had a higher risk of fractures, serious falls, and syncope compared to those who did not receive the medication. Subgroup analysis reveals an even higher risk of fractures in nursing home residents with dementia, elevated systolic or diastolic blood pressure, and those who had not used antihypertensives before. These findings suggest that rapidly decreasing blood pressure in nursing home residents may lead to orthostatic hypotension and subsequent falls and fractures. The study emphasizes the need for caution when initiating or escalating antihypertensive therapy in the older adult nursing home population. The authors suggest monitoring orthostatic vitals and avoiding rapid intensification of medication.