Doctor Measures Blood Pressure In The Patient
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A record analysis of roughly 30,000 nursing home residents has revealed that blood pressure drugs more than double the risk of life-threatening bone fractures. The study from investigators at Rutgers Health, which appears in the journal JAMA Internal Medicine, reveals that higher risk is a result of blood pressure medications’ tendency to impair the balance of people taking them, especially when first standing, which results in temporary oxygen deprivation to the brain.

“Bone fractures often start nursing home patients on a downward spiral,” said lead author Chintan Dave, academic director of the Rutgers Center for Health Outcomes, Policy and Economics. “Roughly 40% of those who fracture a hip die within the next year, so it’s truly alarming to find that a class of medications used by 70 percent of all nursing home residents more than doubles the bone-fracture risk.”

For their research, the Rutgers team used the data from 29,648 patients in long-term care facilities run by the Veterans Health Administration (VHA). To figure out the relative risk of taking these medications. The team compared the 30-day risk of fractures to the hip, pelvis, humerus, radius, or ulna for patients who began taking blood pressure medications versus those who didn’t take them.

To better understand the direct effects of medication use on patient outcomes, the team also adjusted the results for more than four dozen baseline covariates based on clinical history and demographics, among others.

Using this framework, the investigators found that residents who began taking blood pressure medications showed a 30-day fracture risk of 5.4 per 100 residents per year or roughly two-and-a-half times the risk of patients who didn’t take these medications (2.2 fractures per 100 people per year).

More detailed analysis revealed blood pressure medication elevated the risk of patients in particular subgroups such as those suffering from dementia, systolic blood pressure above 139, diastolic blood pressure above 79, or no recent use of blood pressure medication. Patients with these characteristics experienced a tripling of fracture risk.

The team noted that while it is important for patients with high enough blood pressure to receive these medications, it is equally important for caregivers to be cognizant of the dangers even in those patients where the benefit of blood pressure drugs outweighs the increased risk.

“Such patients require careful observation, particularly when treatment begins, and that’s not happening,” Dave noted. “Caregivers think of blood pressure medication as very low risk, and that’s not true in this patient population.”

The Rutgers Health team hopes that their study can alert caregivers in long-term care environments for the elderly to more actively manage patients on these medications including developing way to perhaps provide less medication and more active patient support.

“Caregivers can’t strike this right balance of risk and reward if they don’t have accurate data about the risks,” Dave said. “I hope this study gives them information that helps them serve their patients better.”

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