Newly prescribed antihypertensive medications and risk of hip fracture in the elderly

Background and aim. Hypertension is highly prevalent in the elderly, and antihypertensive medications are among the most prescribed medications worldwide. Postural hypotension represents a common adverse effects of these medications. We assessed the relationship between antihypertensive medications and the risk of hospitalization for hip fracture (HF). Methods. Retrospective population-based study of 80,206 patients from Lombardy (Italy), aged 70-90 years, who were newly treated with antihypertensive agents between 2005 and 2009. Cases were the 2,153 patients who experienced the outcome (hospitalization for HF within December 31, 2012). For each case, three controls were randomly selected from the cohort to be matched for gender, age at cohort entry, and date of starting prescription. The case-control and case-crossover designs, and the logistic regression for matched sets, were used to measure the strength of the association between current use of antihypertensive classes (within 30 days before the HF hospital admission) and the outcome. Results. The final cohort was analysed as a whole and defining two age groups: 70-80 and 81-90 years. Case-crossover odds ratio was 1.49 (95% CI: 1.05-2.10) for current use of loop diuretics. Among patients aged 81-90 years, case-crossover odds ratios were 1.88 (1.01-3.48), 1.38 (1.02-1.88) and 1.82 (1.10-3.00) for α-blockers, diuretics, and loop diuretics respectively. No other antihypertensive classes were associated with the outcome. Conclusions. Current use of diuretics, mainly loop diuretics, and α-blockers, represent risk factors for HF in the elderly. Clinicians should carefully consider the selection of antihypertensive drugs to reduce falls in this group of patients