Questioning Medicine

In a retrospective cohort study of Veterans Affairs (VA) nursing home residents during 2006 to 2019, researchers identified 13,000 residents who initiated a first or additional antihypertensive medication and 52,000 propensity score–matched controls (mean age, 78). The primary outcome was a composite of pelvic fracture, surgically treated hip fracture, and fractures of the humerus, radius, and ulna that required intervention within 30 days of starting antihypertensive medication. Initiating medication also was associated with elevated risks for falls that required emergency room visits or hospitalizations (aHR, 1.8) and elevated risks of syncope (aHR, 1.7). Fracture risks were elevated, compared with controls, in initiators with a  systolic blood pressure ≥140 mm Hg (aHR, 3.1), diastolic blood pressure ≥80 mm Hg (aHR, 4.4), and no recent antihypertensive medication use (aHR, 4.8).