Hui Ting Ang1, Ka Keat Lim2, Yu Heng Kwan2, Pui San Tan3, Kai Zhen Yap1, Zafirah Banu1, Chuen Seng Tan4, Warren Fong5,6,7, Julian Thumboo2,5, Truls Ostbye2, Lian Leng Low8,9,10. 1. Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore. 2. Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Republic of Singapore. 3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK. 4. Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549, Republic of Singapore. 5. Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore, 169856, Republic of Singapore. 6. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 7. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Republic of Singapore. 8. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Republic of Singapore. low.lian.leng@singhealth.com.sg. 9. Department of Family Medicine and Continuing Care, Singapore General Hospital, 20 College Road, Singapore, 169856, Republic of Singapore. low.lian.leng@singhealth.com.sg. 10. SingHealth Duke-NUS Family Medicine Academic Clinical Program, 8 College Road, Singapore, 169857, Republic of Singapore. low.lian.leng@singhealth.com.sg.
Abstract
BACKGROUND: Falls in individuals aged ≥ 60 years may result in injury, hospitalisation or death. The role of anti-hypertensive medications in falls among older adults is unclear. OBJECTIVE: The objective of this study was to assess the association of six anti-hypertensive medication classes, namely α-blockers (AB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), β-blockers (BB), calcium channel blockers (CCB) and diuretics, with the risk of falls, injurious falls or recurrent falls in individuals aged ≥ 60 years compared with non-users. METHODS: We performed systematic searches in PubMed, EMBASE and CINAHL and included cohort, case-control and cross-sectional studies that investigated the associations between the use of anti-hypertensive medication classes and the risk of falls, injurious falls or recurrent falls in older adults (≥ 60 years) reported in English. We assessed study quality using the Newcastle-Ottawa Scale (NOS). Unadjusted and adjusted odds ratios (ORs) were pooled using random effects model. We performed meta-analyses for each anti-hypertensive medication class and each fall outcome. We also performed sensitivity analyses by pooling studies of high quality and subgroup analyses among studies with an average age of ≥ 80 years. RESULTS: Seventy-eight articles (where 74, 34, 27, 18, 13 and 11 of them examined diuretics, BB, CCB, ACEi, AB and ARB, respectively) met our inclusion and exclusion criteria; we pooled estimates from 60 articles. ACEi [OR 0.85, 95% confidence interval (CI) 0.81-0.89], BB (OR 0.84, 95% CI 0.76-0.93) and CCB (OR 0.81, 95% CI 0.74-0.90) use were associated with a lower risk of injurious falls than in non-users. Results in sensitivity and subgroup analyses were largely consistent. CONCLUSION: The use of ACEi, BB or CCB among older adults may be associated with a lower risk of injurious falls than non-use.
BACKGROUND:Falls in individuals aged ≥ 60 years may result in injury, hospitalisation or death. The role of anti-hypertensive medications in falls among older adults is unclear. OBJECTIVE: The objective of this study was to assess the association of six anti-hypertensive medication classes, namely α-blockers (AB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), β-blockers (BB), calcium channel blockers (CCB) and diuretics, with the risk of falls, injurious falls or recurrent falls in individuals aged ≥ 60 years compared with non-users. METHODS: We performed systematic searches in PubMed, EMBASE and CINAHL and included cohort, case-control and cross-sectional studies that investigated the associations between the use of anti-hypertensive medication classes and the risk of falls, injurious falls or recurrent falls in older adults (≥ 60 years) reported in English. We assessed study quality using the Newcastle-Ottawa Scale (NOS). Unadjusted and adjusted odds ratios (ORs) were pooled using random effects model. We performed meta-analyses for each anti-hypertensive medication class and each fall outcome. We also performed sensitivity analyses by pooling studies of high quality and subgroup analyses among studies with an average age of ≥ 80 years. RESULTS: Seventy-eight articles (where 74, 34, 27, 18, 13 and 11 of them examined diuretics, BB, CCB, ACEi, AB and ARB, respectively) met our inclusion and exclusion criteria; we pooled estimates from 60 articles. ACEi [OR 0.85, 95% confidence interval (CI) 0.81-0.89], BB (OR 0.84, 95% CI 0.76-0.93) and CCB (OR 0.81, 95% CI 0.74-0.90) use were associated with a lower risk of injurious falls than in non-users. Results in sensitivity and subgroup analyses were largely consistent. CONCLUSION: The use of ACEi, BB or CCB among older adults may be associated with a lower risk of injurious falls than non-use.
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