- This meta-analysis found no evidence of an association between antihypertensive treatment and falls or fractures.
- However, there was an association between antihypertensive treatment and potentially both mild (hyperkalaemia and hypotension) and severe adverse events (acute kidney injury [AKI] and syncope).
Why this matters
- Findings might be used to inform shared decision-making between physicians and patients about initiation and continuation of antihypertensive treatment, especially in those at high risk of harm because of previous adverse events or poor renal function.
- Meta-analysis of 58 randomised controlled trials including 280,638 participants with a median follow-up duration of 3 years (interquartile range, 2-4 years).
- Primary outcome: falls; secondary outcomes: AKI, fractures, gout, hyperkalaemia, hypokalaemia, hypotension and syncope.
- Funding: Wellcome Trust and Royal Society and others.
- No statistically significant association was seen between antihypertensive treatment and risk of:
- falls (7 studies; risk ratio [RR], 1.05; 95% CI, 0.89-1.24);
- fractures (5 studies; RR, 0.93; 95% CI, 0.58-1.48); and
- gout (5 studies; RR, 3.84; 95% CI, 0.95-15.57).
- Antihypertensive treatment was associated with an increased risk of:
- AKI (15 studies; RR, 1.18; 95% CI, 1.01-1.39; I2, 48.1%);
- hyperkalaemia (26 studies; RR, 1.89; 95% CI, 1.56-2.30; I2, 71.8%);
- hypotension (35 studies; RR, 1.97; 95% CI, 1.67-2.32; I2, 85.1%); and
- syncope (16 studies; RR, 1.28; 95% CI, 1.03-1.59; I2, 42.9%).
- Antihypertensive treatment was associated with a lower risk of:
- all-cause mortality (HR, 0.93; 95% CI, 0.88-0.98; I2, 50.4%);
- cardiovascular death (HR, 0.92; 95% CI, 0.86-0.99; I2, 54.6%); and
- stroke (HR, 0.84; 95% CI, 0.76-0.93).
- Antihypertensive treatment was not significantly associated with myocardial infarction (HR, 0.94; 95% CI, 0.85-1.03).
- Heterogeneity among included studies.