Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-14T05:41:26.875Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiovascular medication and falls

Published online by Cambridge University Press:  19 November 2010

Adam Darowski  and
Robert Whiting
Adam Darowski*
Affiliation:
Department of Clinical Geratology, John Radcliffe Hospital, Oxford, UK
Robert Whiting
Affiliation:
Department of Clinical Geratology, John Radcliffe Hospital, Oxford, UK
*
Address for correspondence: Dr Adam Darowski, Department of Clinical Geratology, Level 4, Academic Block, John Radcliffe Hospital, Oxford OX3 9DU, UK. Email: adam.darowski@msd.ox.ac.uk
Get access Rights & Permissions [Opens in a new window]

Summary

There are inadequate data to formulate evidence-based guidelines on cardiovascular medication and falls. A critical systematic review of medication as a risk factor for falls concluded that there was a weak association between drugs that reduce blood pressure and falls. The population studies reviewed, looking for an association between cardiovascular drug usage and falls, consisted of subjects who were much younger and who had a much lower drug burden when compared with the older clinic population. The magnitude of the effect of cardiovascular medications on falls may therefore have been underestimated in these studies.

Two observational studies in falls clinics showed significant reductions in falls and syncope following withdrawal of cardiovascular medication, with improvements in symptoms, in tilt-table parameters predictive of syncope, and in measures of gait and balance.

There are no randomized controlled trials of the effect of cardiovascular drug withdrawal on falls. An expert audience of 200 members attending the 2009 British Geriatrics Society Falls Section Conference held the unanimous opinion that cardiovascular medications were a significant cause of falls in older people.

Keywords

cardiovascular drugsfallssyncope
Type
Intermediate care and rehabilitation
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 2 , May 2011 , pp. 170 - 179
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systemic review and meta-analysis II: cardiac and analgesic drugs. J Am Geriatr Soc 1999; 47: 40–50.CrossRefGoogle Scholar
2Hartikainen, S, Lonnroos, E, Louhivuori, K. Medication as a risk factor for falls: critical systematic review. J Gerontology 2007; 62A: 1172–81.Google Scholar
3Woolcott, JC, Richardson, KJ, Wiens, MO, Patel, B, Marin, J, Khan, KM, Marra, CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009; 169: 195–260.CrossRefGoogle ScholarPubMed
4Feder, G, Cryer, C, Donovan, S, Carter, Y. Guidelines for the prevention of falls in people over 65. BMJ 2000; 321: 1007–11.CrossRefGoogle ScholarPubMed
5Darowski, A, Chambers, SCF, Chambers, DJ. Antidepressants and falls. Drugs Aging 2009; 26: 381–94.CrossRefGoogle ScholarPubMed
6Campbell, AJ, Robertson, MC, Gardner, MM, Norton, RN, Buchner, DM. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 1999; 47: 850–53.CrossRefGoogle Scholar
7Alsop, K, MacMahon, M. Withdrawing cardiovascular medications at a syncope clinic. Postgrad Med J 2001; 77: 403–5.CrossRefGoogle Scholar
8Van Der Velde, N, Ziere, B, Van Der Cammen, TJM. Drugs and falls in older persons: potential for reversibility? Eur J Geriatrics 2004; 6: 187–92.Google Scholar
9Van Der Velde, N, Van Den Meiracker, AH, Pols, HA, Stricker, BH, Van Der Cammen, TJ. Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes. J Am Geriatr Soc 2007; 55: 734–39.CrossRefGoogle ScholarPubMed
10Darowski, A. Falls: The Facts. Oxford, OUP, 2008.CrossRefGoogle Scholar
11Sorond, FA, Galica, A, Serrador, JM, Kiely, DK, Iloputaife, I, Cupples, LA, Lipsitz, LA. Cerebrovascular hemodynamics, gait, and falls in an elderly population. Neurology 2010; 74: 1627–33.CrossRefGoogle Scholar
12Turnheim, K. Geriatric pharmacology: Pharmacokinetics and pharmacodynamics in the elderly, geriatric and nootropic drugs. Wien Klin Wochenschr 1995; 107: 349–56.Google ScholarPubMed
13Mannesse, CK, Van Der Cammen, TJM. Adverse drug reactions in three older patients, even without changes in medication. Ned Tijdschr Geneesk 2003; 147: 585–87.Google ScholarPubMed
14Mannesse, CK, Derkx, FMH, De Ridder, MAJ, Man in't Veld, AJ, Van Der Cammen, TJM. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000; 29: 203–10.Google ScholarPubMed
15Müller, ME, Van Der Velde, N, Krulder, JWM, Van Der Cammen, TJM. Syncope and falls due to timolol eye drops. BMJ 2006; 332: 960–61.CrossRefGoogle ScholarPubMed
16Van Der Velde, N, Ziere, B, Van Der Cammen, TJM. Falls in three patients due to timolol eye drops, tolterodine, and flecainide. J Gerontol A Biol Sci Med Sci 2004; 12: 1243–44.Google Scholar
17Zeeh, J, Platt, D. The ageing liver. Gerontology 2002; 48: 121–27.CrossRefGoogle Scholar
18Jansen, PAF. Pitfalls in drug use of the elderly. Gebu 2000; 34: 53–59.Google Scholar
19Gral, T, Young, M. Measured versus estimated creatinine clearance in the elderly as an index of renal function. J Am Geriatr Soc 2002; 50: 1629–37.Google Scholar
20Jansen, PAF. Clinical relevant drug interactions in the elderly. Ned Tijdschr Geneesk 2003; 147: 595–99.Google ScholarPubMed
21Centers for Disease Control and Prevention. Leading Causes of Non-fatal Injury Reports. Available at: webapp.cdc.gov/sasweb/ncipc/nfilead.html (accessed 24 May 2010).Google Scholar
22Grimley Evans, J. Evidence-based and evidence-biased medicine. Age Ageing 1995: 24: 461–63.CrossRefGoogle Scholar
23Aguado, A, López, F, Miravet, S, Oriol, P, Fuentes, MI, Henares, B, Badia, T, Esteve, L, Peligro, J. Hypertension in the very old; prevalence, awareness, treatment and control: a cross-sectional population-based study in a Spanish municipality. BMC Geriatrics 2009; 9: 16.CrossRefGoogle Scholar
24Staessen, JA, Gasowski, J, Wang, JG, Thijs, L, Den Hond, E, Boissel, JP, Coope, J, Ekbom, T, Gueyffier, F, Liu, L, Kerlikowske, K, Pocock, S, Fagard, RH. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000; 355: 865–72.CrossRefGoogle ScholarPubMed
25Dahlöf, B, Lindholm, LH, Hansson, L, Scherstén, B, Ekbom, T, Wester, PO. Morbidity and mortality in the Swedish Trial in Old Patients with hypertension (STOP-hypertension). Lancet 1991; 338: 1281–85.CrossRefGoogle ScholarPubMed
26SHEP Co-operative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–64.CrossRefGoogle Scholar
27Cooper, C, Melton, LJ III. Epidemiology of osteoporosis. Trends Endocrinol Metab 1992; 314: 224–29.CrossRefGoogle Scholar
28Staessen, JA, Fagard, R, Thijs, L, Celis, H, Arabidze, GG, Birkenhäger, WH, Bulpitt, CJ, de Leeuw, PW, Dollery, CT, Fletcher, AE, Forette, F, Leonetti, G, Nachev, C, O'Brien, ET, Rosenfeld, J, Rodicio, JL, Tuomilehto, J, Zanchetti, A. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.CrossRefGoogle ScholarPubMed
29Liu, L, Wang, JG, Gong, L, Liu, G, Staessen, JA, for the Systolic Hypertension in China (Syst-China) Collaborative Group. Comparison of active treatment and placebo for older patients with isolated systolic hypertension. J Hypertens 1998; 16: 1823–29.CrossRefGoogle ScholarPubMed
30Staessen, J, Bulpitt, C, Clement, D et al. Relation between mortality and treated blood pressure in elderly patients with hypertension: Report of the European Working Party on High Blood Pressure in the Elderly. BMJ 1989; 298: 1552–56.CrossRefGoogle Scholar
31Coope, J, Warrender, TS. Randomised trial of treatment of hypertension in elderly patients in primary care. BMJ 1986; 293: 1145–51.CrossRefGoogle ScholarPubMed
32MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992; 304: 405–12.CrossRefGoogle Scholar
33Bulpitt, CJ, Peters, R, Staessen, JA, Thijs, L, de Vernejoul, MC, Fletcher, AE, Beckett, NS. Fracture risk and the use of a diuretic (indapamide sr) ± perindopril: a substudy of the Hypertension in the Very Elderly Trial (HYVET). Trials 2006; 7: 33CrossRefGoogle ScholarPubMed
34Beckett, NS, Peters, R, Fletcher, AE, Staessen, JA, Liu, L, Dumitrascu, D, Stoyanovsky, V, Antikainen, RL, Nikitin, Y, Anderson, C, Belhani, A, Forette, F, Rajkumar, C, Thijs, L, Banya, W, Bulpitt, CJ; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. NEJM 2008; 358: 1887–98.CrossRefGoogle ScholarPubMed
35Heiat, A, Gross, CP, Krumholz, HM. Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med 2002; 162: 1682–88.CrossRefGoogle ScholarPubMed
36Komajda, M, Hanon, O, Hochadel, M, Lopez-Sendon, JL, Follath, F, Ponikowski, P, Harjola, VP, Drexler, H, Dickstein, K, Tavazzi, L, Nieminen, M. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J 2009; 30: 478–86.CrossRefGoogle ScholarPubMed
37Cleland, JG, Tendera, MAdamus, JFreemantle, N, Polonski, L, Taylor, J; PEP-CHF Investigators. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 2006; 27: 2338–45.CrossRefGoogle ScholarPubMed
38Soteriades, ES, Evans, JC, Larson, MG, Chen, MH, Chen, L, Benjamin, EJ, Levy, D. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878–85.CrossRefGoogle ScholarPubMed
39Lipsitz, LA, Pluchino, FC, Wei, JY et al. Syncope in an elderly instituzionalized population: prevalence, incidence and associated risk. Q J Med 1985; 55: 45–54.Google Scholar
40Shaw, FE, Kenny, RA. The overlap between syncope and falls in the elderly. Postgrad Med J 1997; 73: 635–39.CrossRefGoogle ScholarPubMed
41Nevitt, MC, Cummings, SR, Kidd, S. Risk factors for recurrent non-syncopal falls. A prospective study. JAMA 1989; 261: 2663–67.CrossRefGoogle Scholar
42McIntosh, SJ, da Costa, D, Kenny, RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a syncope clinic. Age Ageing 1993; 22: 53–55.CrossRefGoogle Scholar
43Davies, AJ, Kenny, RA. Falls presenting to the Accident and Emergency Department: types of presentation and risk factor profile. Age Ageing 1996; 25: 362–66.CrossRefGoogle Scholar
44Brignole, M, Alboni, P, Benditt, DG, Bergfeldt, L, Blanc, JJ, Bloch Thomsen, PE, van Dijk, JG, Fitzpatrick, A, Hohnloser, S, Janousek, J, Kapoor, W, Kenny, RA, Kulakowski, P, Masotti, G, Moya, A, Raviele, A, Sutton, R, Theodorakis, G, Ungar, A, Wieling, W; Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope – update 2004. Europace 2004; 6: 467–537.Google ScholarPubMed
45Carey, BJ, Potter, JF. Cardiovascular causes of falls. Age Ageing 2001; 30: 19–24.CrossRefGoogle ScholarPubMed
46Iyer, S, Naganathan, V, McLachlan, AJ, Le Couteur, DG. Medication withdrawal trials in people aged 65 years and older. Drugs Aging 2008; 25: 1021–31.CrossRefGoogle ScholarPubMed
47Poon, IO, Braun, U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005; 30: 173–78.CrossRefGoogle ScholarPubMed
48Kenny, RA, Kalaria, R, Ballard, C. Neurocardiovascular instability in cognitive impairment and dementia. Ann NY Acad Sci 2002; 977: 183–95.CrossRefGoogle ScholarPubMed
49Novak, V, Novak, P, Spies, LM, Low, PA. Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke 1998; 29: 104–11.CrossRefGoogle ScholarPubMed
50Parry, SW, Tan, MP. An approach to the evaluation and management of syncope in adults. BMJ 2010; 340: 880.CrossRefGoogle Scholar
51Graafmans, WC, Ooms, ME, Hofstee, HM, Bezemer, PD, Bouter, LM, Lips, P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996; 143: 1129–36.CrossRefGoogle ScholarPubMed
52Seifer, C, Kenny, RA. The prevalence of falls in older persons paced for atrioventricular block and sick sinus syndrome. Am J Geriatric Cardiol 2008; 12: 298–307.CrossRefGoogle Scholar
53Moya, A, Sutton, R, Ammirati, F et al. Guidelines on diagnosis and management of syncope – version 2009. Eur Heart J 2009; 30: 2631–71.Google ScholarPubMed
54Parry, SW, Matthews, I. The implantable loop recorder in older patients with syncope: is sooner better? Age Ageing 2010; 39: 284–85.CrossRefGoogle ScholarPubMed
55Kenny, RA, Richardson, DA, Steen, N, Bexton, RS, Shaw, FE, Bond, J. Carotid sinus syndrome: modifiable risk factors for non-accidental falls in older adults (Safe Pace). J Am Coll Cardiol 2001; 38: 1491–96.CrossRefGoogle ScholarPubMed
56Kumar, NP, Thomas, A, Mudd, P, Morris, RO, Masud, T. The usefulness of carotid sinus massage in different patient groups. Age Ageing 2003; 32: 666–69.CrossRefGoogle ScholarPubMed
57Kenny, RA, McIntosh, S. Carotid sinus syndrome. In Kenny, RA (ed), Syncope in the Older Patient. London: Chapman & Hall, 1996: pp. 107–23.Google Scholar
58Alboni, P, Brignole, M, Menozzi, C, Raviele, A, Del Rosso, A, Dinelli, M, Bettiol, K, Bottoni, N, Solano, A. Clinical spectrum of neurally mediated reflex syncopes. Europace 2004; 6: 55–62.CrossRefGoogle ScholarPubMed
59Bergland, A, Wyller, TB. Risk factors for serious fall related injury in elderly women living in home. Inj Prev 2004; 10: 308–13.CrossRefGoogle Scholar
60Rozenfeld, S, Camacho, LA, Veras, P. Medications as a risk factor for falls in older women in Brazil. Rev Panam Salud Publica 2003; 13: 369–75.CrossRefGoogle ScholarPubMed
61Chu, LW, Chi, I, Chiu, AY. Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singapore 2005; 3: 60–72.CrossRefGoogle Scholar
62Lawlor, DA, Patel, R, Ebrahim, S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 2003; 327: 712–17.CrossRefGoogle ScholarPubMed
63Kelly, KD, Pickett, W, Yiannakoulias, N, Rowe, BH, Schopflocher, DP, Svenson, L, Voaklander, DC. Medication use and falls in community-dwelling older persons. Age Ageing 2003; 32: 503–9.CrossRefGoogle ScholarPubMed
64Lee, JSW, Kwok, T, Leung, PC, Woo, J. Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age Ageing 2006; 35: 246–51.CrossRefGoogle ScholarPubMed
65Mustard, CA, Mayer, T. Case-control study of exposure to medication and the risk of injurious falls requiring hospitalisation among nursing home residents. Am J Epidemiol 1997; 145: 738–45.CrossRefGoogle ScholarPubMed
66Burr, ML, King, S, Davies, HE, Pathy, MS. The effects of discontinuing long-term diuretic therapy in the elderly. Age Ageing 1977; 6: 38–45.CrossRefGoogle ScholarPubMed
67Myers, MG, Weingert, ME, Fisher, RH, Gryfe, CI, Shulman, HS. Unnecessary diuretic therapy in the elderly. Age Ageing 1982; 11: 213–21.CrossRefGoogle ScholarPubMed
68de Jonge, JW, Knottnerus, JA, van Zutphen, WM, de Bruijne, GA, Struijker Boudier, HA. Short-term effect of withdrawal of diuretic drugs prescribed for ankle oedema. BMJ 1994; 308: 511–13.CrossRefGoogle ScholarPubMed
69Walma, EP, Hoes, AW, van Dooren, C, Prins, A, Van Der Does, E. Withdrawal of long-term diuretic medication in elderly patients: a double-blind randomised trial. BMJ 1997; 315: 464–68.CrossRefGoogle ScholarPubMed
70Kario, K, Tobin, JN, Wolfson, LI, Whipple, R, Derby, CA, Singh, D, Marantz, PR, Wassertheil-Smoller, S. Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study. J Am Coll Cardiol 2001; 38: 246–52.CrossRefGoogle ScholarPubMed