Editor’s View

摘要

The use of anti-hypertensive treatment is widely considered to be a risk factor for falls in older people, possibly mediated through the development of orthostatic hypotension. The results of studies examining the relationship between these treatments and falls have been inconsistent and few have investigated the effect of different classes of anti-hypertensive agents. A case–control study reported in this issue (pp. 592–597) examines the relationship between anti-hypertensive treatment and documented falls in older people, using data from The Health Improvement Network primary care database in the United Kingdom. The investigators identified 9,682 patients above the age of 60 years with a first fall documented between 2003 and 2006, together with up to six control subjects matched by age, gender and general practice. After adjusting for confounding variables, they report a small increased risk of falls in patients who were currently prescribed a thiazide diuretic, which was more marked in the 3 weeks after the first prescription. In contrast, there was a lower risk of falls in those currently prescribed beta blockers, but there was no relationship between other anti-hypertensive treatments and the risk of falls. Despite the limitations of the study highlighted in the discussion, the results suggest that older patients starting thiazides should be monitored closely in the first few weeks of treatment.