Blood Pressure Drugs Linked to More Fractures, Falls in VA Nursing Homes (2024)

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May 24, 2024

First do no harm

Philip Altus, MD, MACP | Professor Emeritus, Dept of Internal medicine, University of South Fl

This should not be a surprise. trying to get the elderly and nursing home pts' BP down to what the ivory tower suggest is just BAD medicine. What are those Doc's trying to prevent - long term complications. Because of "stiff" vessels, the elderly often have falsely high BP readings when taken with a cuff. This combined with neuropathies causing orthostatic changes leads to falls, fractures and death.

CONFLICT OF INTEREST: None Reported

May 25, 2024

Changing Views

Arvind Joshi, MBBS MD FCGP FAMS FICP | Convener: Our Own Discussion Group Mumbai INDIA

Conventional wisdom suggests that Franklin Delano Roosevelt died on 12 April 1945 aged 63 from a massive cerebral haemorrhage attributable to uncontrolled hypertension and atherosclerosis.
https://pubmed.ncbi.nlm.nih.gov › ...
The untold neurological disease of Franklin Delano Roosevelt (1882 ...

Probably this incident triggered review of how to look at the Blood Pressure Numbers.

In 1960s and 1970s doctors used to consider Age + 90 as a good Systolic Blood Pressure.

Numbers came down to 140 and then 120 mm Hg as desirable Systolic Blood Pressure.

Now it seems that such low Systolic Blood Pressure

CONFLICT OF INTEREST: None Reported

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May 26, 2024

Undefined Scope of "Blood Pressure Drugs"

Paul Schneck, BS, MS, PhD | Consultant, non-medical (PhD, Computer Science)

Antihypertensives as a category of drugs for treating hypertension includes beta‐blockers, calcium‐channel blockers (CCBs), diuretics(both thiazide and loop), and renin‐angiotensin system (RAS) inhibitors. It is well known that thiazide diuretics reduce excretion of calcium and loop diuretics increase excretion of calcium. Describing the effects of antihypertensives with a broad brush statement such as "antihypertensives were associated with a greater risk of fractures among people with dementia, as well as among those with higher baseline blood pressure or who hadn’t previously used antihypertensive medications" raises the question "Is the cause of greater risk of fractures among those using antihypertensives due to greater excretion due to (frequent) use of loop diuretics or is there some other cause?" Alternatively, is there a greater fracture risk among users of beta-blockers, CCBs, or RAS inhibitors? The broad conclusion of the note is not useful without examining causality more closely.
Paul Schneck

CONFLICT OF INTEREST: None Reported

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May 31, 2024

Which Antihypertension Medicines increase risk of Falls in the Elders

Arvind Joshi, MBBS MD FCGP FAMS FICP | Convener Our Own Discussion Group Mumbai INDIA

Dr Paul Schneck has raised a valid point - whether CCB Beta blockers or RAS inhibitors are more likely to increase risk of Falls in the Elders.

Subgroup Analyses will not end at that.

One will need categorisation of the subjects such as
Autonomic Neuropathy
Sensory Neuropathy
Cerebrovascular Atherosclerosis and the regions of brain affected
Joint position sense
Vestibular apparatus function
Cerebellar Function

The Antihypertension Medicines will need to include other classes such as
Duretics
Central Alpha Agonists

Also, there may not be single

CONFLICT OF INTEREST: None Reported

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