Medical Research: What are the main findings of the study?
Dr. Margolis: The study compared falls and fractures in patients aged 40-79 with diabetes who were treated for high blood pressure. One group received treatment that aimed at getting systolic blood pressure under 120, while the other group received treatment to achieve systolic blood pressure under 140. The results show that patients who received intensive blood pressure treatment did not fall more than less intensively treated patients, nor did they incur more fractures over an average follow-up of about five years.
Medical Research: Were any of the findings unexpected?
Dr. Margolis: Many physicians and patients worry that tightly controlling high blood pressure can increase the risk of low blood pressure that causes people to fall and break a bone. This study contradicts that belief; in fact study participants in the intensive blood pressure treatment group showed a trend toward fewer fractures than the less intensively treated group. This might be related to bone-preserving properties of some of the antihypertensive drugs that were used more often in the intensive group.
Medical Research: What should clinicians and patients take away from your report?
Dr. Margolis: Our study calls into question whether the commonly cited concern about the long-term risk of falls and fractures should influence the way blood pressure is treated in older people and those with diabetes. Instead, perhaps doctors and patients should focus on avoiding other well-established drug side effects, while treating blood pressure to levels that have been shown to prevent cardiovascular complications like heart attacks and strokes.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Margolis: Additional analyses in ACCORD and studies in other populations are needed to understand how blood pressure treatment may influence risk of falls and fractures, including effects on orthostatic hypotension (a blood pressure drop upon standing) and orthostatic dizziness (dizziness upon standing).
- Karen L. Margolis MD, MPH,Lisa Palermo MA,Eric Vittinghoff PhD,Gregory W. Evans MS,Hal H. Atkinson MD, MS,Bruce P. Hamilton MD,Robert G. Josse MD,Patrick J. O’Connor MD, MPH,Debra L. Simmons MD, MS, Margaret Tiktin NP,
- Journal of General Internal Medicine August 2014 Date: 16 Aug 2014