Intensive BP Control Falls and Fractures

Excerpt

In the study by Margolis et al., although the adjusted rate of falls did not differ in the intensive and standard groups during the course of antihypertensive therapy,1 it is worth noting that no account was taken of whether or not there might be a difference between the two groups in the prevalence of orthostatic hypotension. Orthostatic hypotension is age-related in its prevalence, and is also associated with antihypertensive treatment and diabetes, respectively.2 Furthermore, although orthostatic blood pressure responses stabilize within 30 seconds of standing in subjects aged 50–59 years, there is an impairment of blood pressure stabilization with increasing age.3 Typical symptoms of orthostatic hypotension may be absent in subjects who have orthostatic hypotension. In a study that enrolled 205 subjects of mean age 71, 33 % of the subjects were asymptomatic despite profound falls in blood pressure during the head-up tilt table test.4 Accordingly, although the raw rate of falls was comparable in the intensively treated subjects vs, the standard treatment group,1 what we need to know is whether or not orthostatic hypotension (and its severity) might have contributed to falls in either group. …