Risk factors for falls in patients with arterial hypertension

Falls are a serious multi-factorial problem faced by the elderly persons which is associated with serious complications, loss of functional autonomy, disability and death. One of the common comorbidities among the elderly persons is arterial hypertension (AH) which increases the risk of falls. Aim. To study the risk factors for falls among patients with AH. Materials and methods. Examined 155 patients of geriatric department with the presence of at least one fall in the last year: 133 (85.8%) women (75,29±8.31 years) and 22 (14.2%) men (79,14±4.64 years). Risk of falls and risk factors of falls were assessed in patients with AH. Results. 148 (95.5%) patients had AH. The most common risk factors for hypertension in the elderly were atherosclerosis and decreased physical activity. Target organ lesions of varying severity were observed in all patients. In 25.7% of cases, BP figures outside the target values were noted. 18 (12.2%) patients received hypotensive therapy irregularly. On avera-ge, at admission, patients received of 2.06±0.63 anti-hypertensive drug. The frequency of falls in patients with hypertension made up 2.59±2.2, two or more falls happened in 91 persons (61.5%). According to the self-assessment risk of falls scale 131 (88.5%) patients had a high risk of falls. A high risk of falling in hospital (on the Morse scale) was identified in 63 (42.6%) patients. The most common risk factors for falls in patients with AH were previous falls in anamnesis, sensory de-ficit, imbalance, osteoarthritis. The CGA results demonstrate that patients with hypertension with blood pressure below the target values in comparison with the target and even high numbers of blood pressure have a higher prevalence of frailty, worse indicators of functional status, higher incidence and high risk of falls on the Morse scale. Conclusion. The most common risk factors for falls among patients with AH are previous falls in anamnesis, sensory deficit, imbalance, osteoarthritis. For patients with hypertension, low blood pressure is a predictor of high risk of falls and a worse prognosis. When blood pressure is below the target, there is a higher prevalence of frailty and worse indicators of functional status, which is a poor prognostic sign for the elderly.

falls, fractures, elderly people, disability, mortality, arterial hypertension, orthostatic hypotension

1. Soriano T.A, DeCherrie L.V, Thomas D.C. Falls in the community-dwelling older adult: a review for pri-mary-care providers. Clin Interv Aging 2007; 2 (4): 545-54.

2. Ferrer A, Formiga F, Sanz H et al; OCTABAIX Study Group. Multifactorial assessment and targeted in-tervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9: 383-93.

3. Imhof L, Naef R, Wallhagen M.I et al. Effects of an advanced practice nurse in-home health consulta-tion program for community-dwelling persons aged 80 and older. J Am Geriatr Soc 2012; 60 (12): 2223-31.

4. Fuller G.F. Falls in the elderly. Am Fam Physician 2000; 61 (7): 2159-68, 2173-4.

5. Ministry of Health, Labour and Welfare. The Outline of the Results of the National Livelihood Survey. Available online: https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/s1_2_2.html (accessed on 4 April 2019).

6. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299-303.

7. Web-based Injury Statistics Queryand Reporting System (WISQARS) website. https://www.cdc.gov/ injury/wisqars/. 2016. Accessed November 8, 2017.

8. Bergen G, Stevens M.R, Burns E.R. Falls and fall injuries among adults aged 65 years United States, 2014. MMWR Morb Mortal Wkly Rep 2016; 65 (37): 993-8.

9. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Gui-deline for Prevention of Falls in Older Persons. J Am Geriatr Soc 2011; 59 (1): 148-57.

10. Costa-Dias M.J.M, Ferreira P.L. Fall risk assessment tools. Rev Enferm Ref 2014; IV (2): 153-61.

11. Oliveira R.M et al. Strategies for promoting patient safety: from the identification of the risks to the evidence-based practices. Esc Anna Nery 2014; 18 (1): 122-9.

12. Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab 2014; 11: 222-5.

13. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299-303.

14. Leipzig R.M, Cumming R.G, Tinetti M.E. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30-9.

15. Fortin M, Bravo G, Hudon C et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223-8.

16. Kenny R.A, Richardson D.A, Steen N et al. Carotid sinus syndrome: A modifiable risk factor for nonacci-dental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491-6.

17. Falcão R.M.M, Costa K.N.F.M, Fernandes M.D.G.M et al. Risk of falls in hospitalized elderly people. Rev Ga-ucha Enferm 2019; 40 (spe): e20180266. DOI: 10.1590/1983-1447.2019.20180266

18. Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 1996; 6: 125-6. DOI: 10.1007/BF02291236.

19. ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-

20. DOI: 10.1093/eurheartj/ehy339

21. Tinetti M.E, Han L, Lee D.S et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174 (4): 588. DOI: 10.1001/jamain-ternmed.2013.14764

22. Corrao G, Mazzola P, Monzio Compagnoni M et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81,617 Italian patients newly treated between 2005 and 2009. Drugs Aging 2015; 32: 927-36.

23. Kjeldsen S.E, Stenehjem A, Os I et al. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25: 333-6.

24. Perez-Castrillon J.L, Martin-Escudero J.C, Alvarez Manzanares P et al. Hypertension as a risk factor for hip fracture. Am J Hypertens 2005; 18: 146-7.

25. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019; 16 (1): 6-31. DOI: 10.26442/2075082X.2019.1.190179

26. White D.K, Neogi T, Nevitt M.C et al. Trajectories of gait speed predict mortality in well-functioning ol-der adults: the Health, Aging and Body Composition study. J Gerontol A Biol Sci Med Sci 2012; 68 (4): 456-64. DOI: 10.1093/gerona/gls197