2024.05 Ep 3: Antihypertensive medication and fracture risk in nursing home residents

In this episode, we will discuss a recently published study that observed the association between the initiation of antihypertensive medication and the increased fracture risk in individuals residing in long term care nursing homes.

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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.

Episode Transcript

(00:04):
Welcome to the First Fill.
My name is Maya Harris.
I'm an executive resident here at APhA,and I am delighted to be your host again.
So this month we are reviewing recent updatesrelated to medication safety.
And in this episode,I'm going to talk about a recently published study
that found that the initiationof antihypertensive medication was associated

(00:27):
with increased fracture risk in adults
residing in long term care nursing homes.
So I really wanted to share this studyand its findings with you all because long
term care pharmacists play a crucial rolein providing services to residents of facilities
such as nursing homes, assisted living communitiesand skilled nursing facilities.

(00:49):
And of course, hypertensionis a very common condition
that pharmacists help to manage in older adults.
The condition is so common that,according to the CDC,
the prevalence of hypertensionamong adults aged 60
and over is 63.1%.
And of course, since we are

(01:10):
discussing bone fracturerisk and long term care in nursing homes,
I also wanted to just provide you allwith an interesting statistic
that was publishedin the Journal of the American Geriatrics Society.
So this study conducted by Oullet spelled 0ullet
et al found that between 18 to 33% of older adults

(01:34):
who suffered from a hip fracturewill die within a year.
And alongside this increased mortality risk
are the added challenges that may impactan individual's activities of daily living,
such as bathing, feeding themselves,and even getting dressed.
And so this really further highlightsthe need for pharmacists

(01:55):
to be aware of those risks of fracture associated
with antihypertensive medicationand nursing home residents.
So now I want to give you all a chance
to get into this retrospective cohort studyby Dave et al that used data
from 29,648 adults living in Veterans

(02:17):
HealthAdministration in long term care nursing homes.
So the primary outcome was
non traumatic fracture of either the humerus, hip,
pelvis radius or on within 30 days
of initiating antihypertensive medication.
And the results were observedacross different subgroups of residents,

(02:38):
including across systolic and diastolic
blood pressure thresholds of 140and 80 millimeters.
of mercury, residents with dementia
and the use of prior antihypertensive therapies.
Now, interestingly,the study found that the fracture incidence rate
per 100 person years was 5.4

(03:01):
among residentsstarting antihypertensive medication
compared to 2.2 in the control group,
which makes antihypertensive medications
and that group at double the risk.
And so when it comes to the different subgroupsthat were studied,
the fracture risk was significantly higher.

(03:22):
Now, the residents with dementiawere a little over
three times more at risk of fracturethan the residents without dementia.
Residents with systolic bloodpressure of 140 millimeters of mercury or higher,
or also a little over three times more atrisk of fractures compared to the reference group.
Now, the residents with diastolic blood pressure

(03:44):
of 80 millimeters of mercuryor higher were a little over
four times more at risk of fracturescompared to the reference group.
Also, residents who were
newly initiated on antihypertensive therapywith no recent history of use
were nearly five times at risk of fractures.

(04:04):
Now, as a pharmacist understandingthe risk allows us to closely monitor patients
and potentially mitigate adverse outcomes.
Now, for those that reside in nursing homesand are being initiated on blood pressure
medication, that will mean additional patientcounseling on that increased risk,
especially in those patientswith a history of fractures.

(04:27):
And the incorporation of fractures assessmentswhen appropriate.
Now, because this study focused on the initiationof antihypertensive medications,
the results supportthat close attention should be paid to residents
of nursing homesthat are starting blood pressure medication.
Since it was found to be associated with doublethe increased risk of bone fractures

(04:50):
in nursing home residents,and that is especially for those
with dementia, systolic blood pressure over140 millimeters of mercury diastolic blood
pressure, over 80 millimeters of mercuryand those with no prior antihypertensive use.
So thank you all so much for joining me today.
I hope that you feel really preparedto keep your patients safe and informed.

(05:15):
Please do not forget to headto learn.pharmacist.com
to earn your medication safety CPE for listening.
See you next time.