Abstract: PO1693
Intensive Blood Pressure Control and Fall Injuries in Older Adults: A Systematic Review and Meta-Analysis
Session Information
- Advances in Geriatric Nephrology
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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
| Study | Design | Definition of intensive BP control | Age (years) | Follow up (years) | Total number of patients | Male (%) | Smoker (%) | Obesity (%) | Diabetes Mellitus (%) | Myocardial infarction (%) | Heart failure (%) | Cognitive impairment (%) | Prior falls (%) |
| Callisaya 2014 | Prospective cohort | 0 or >3 medications | >60 | 1.0 | 237 | 57.4 | 53.6 | N/A | 11.8 | 11.0 | N/A | N/A | 18.1 |
| SHEP | RCT | active treatment or placebo | >60 | 4.5 | 4736 | 43.2 | 49.8 | N/A | 10.1 | 4.9 | N/A | 1.7 | N/A |
| Sink 2018 | RCT | sBP target <140 or <120 | >75 | 3.3 | 2242 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| SPRINT | RCT | sBP target <140 or <120 | >75 | 3.3 | 2636 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Tinetti 2014 | PS matched cohort | 0 to <0.2 DDD or >2.5 DDD | >70 | 3.0 | 1394 | 41.6 | 7.2 | 16.2 | 32.5 | 1.6 | 23.0 | 16.0 | 8.5 |
BP: Blood pressure; RCT: Randomized controlled trial
Forrest plot