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Abstract: PO1693

Intensive Blood Pressure Control and Fall Injuries in Older Adults: A Systematic Review and Meta-Analysis

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Wakabayashi, Mako, Nihon Ika Daigaku Fuzoku Byoin, Bunkyo-ku, Tokyo, Japan
  • Yamada, Takayuki, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

Hypertension is the leading preventable risk factor for cardiovascular disease (CVD), and its prevalence increases with age. While prior studies suggested that intensive blood pressure (BP) control achieved a reduction in CVD, antihypertensive treatments can cause adverse events such as falls. Falls are one of the leading causes of hip fractures and traumatic brain injuries. However, it remains unclear if intensive BP control could lead to an increased risk of falls.

Methods

We performed a systematic literature search up to April 2020. We selected randomized control trials (RCTs) and cohort studies which compared the risk of falls in the intensive BP control group with that in the less intensive control group the elderly. Risk ratios (RRs) with corresponding 95% confidence interval (CI) were synthesized.

Results

Five studies (three RCTs and two cohort studies) were included, with 11,245 patients. The characteristics were shown in Table. Intensive BP control was no associated with significantly increased risk of falls, but the results showed high heterogeneity. (RR [95% CI]; 1.10 [0.87-1.39], I2= 73%)

Conclusion

In older patients, intensive BP control was not associated with an increased risk of falls, but with high heterogeneity. The proportion of frail patients might be a source of heterogeneity. Further studies that stratify patients with risk of frail are needed.

Characteristics of the studies included in the Meta-analysis
StudyDesign Definition of intensive BP controlAge (years)Follow up (years)Total number of patientsMale (%)Smoker (%)Obesity (%)Diabetes Mellitus (%)Myocardial infarction (%)Heart failure (%)Cognitive impairment (%)Prior falls (%)
Callisaya 2014Prospective cohort0 or >3 medications>601.023757.453.6N/A11.811.0N/AN/A18.1
SHEPRCTactive treatment or placebo>604.5473643.249.8N/A10.14.9N/A1.7N/A
Sink 2018RCTsBP target <140 or <120>753.32242N/AN/AN/AN/AN/AN/AN/AN/A
SPRINTRCTsBP target <140 or <120>753.32636N/AN/AN/AN/AN/AN/AN/AN/A
Tinetti 2014PS matched cohort0 to <0.2 DDD or >2.5 DDD>703.0139441.67.216.232.51.623.016.08.5

BP: Blood pressure; RCT: Randomized controlled trial

Forrest plot