In the Journals

Falls, syncope significantly high in older community-dwelling adults

Rates of injurious falls and syncope were approximately five times higher in older adults who met inclusion criteria for the Systolic Blood Pressure Intervention Trial compared with adults in the standard care group in the trial, according to a research letter published in JAMA Internal Medicine. Researchers warned that these risks must be considered before starting more intensive BP lowering regimens in this patient population.

“The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that treating adults 75 years of age or older with hypertension to reach a systolic blood pressure target of less than 120 mm Hg compared with a systolic blood pressure target of less than 140 mm Hg reduced the numbers of cardiovascular events and death without a significant increase in the number of injurious falls or syncope,” Donal J. Sexton, BSc, MD, from Trinity College Dublin in Ireland, and colleagues wrote. “However, prior to the adoption of an intensive strategy to lower systolic blood pressure in the oldest segment of the population, it is prudent to determine if individuals meeting inclusion criteria for SPRINT outside the clinical trial context are similar to trial participants, especially with regard to risk for adverse outcomes.”

Sexton and colleagues compared the baseline rates of injurious falls and syncope between community-dwelling adults aged 50 years and older from the Irish Longitudinal Study on Ageing (TILDA) and the standard care group of SPRINT. Participants in the TILDA study (n = 407) completed an in-home interview, a self-reported questionnaire (n=8,175) and a comprehensive health assessment (n=5,751). TILDA participants had a mean follow-up of 3.4 years, whereas SPRINT participants had a median follow-up of 3.4 years. All participants in the TILDA study were white, whereas 74.8% of participants in the SPRINT study were white. The researchers identified participants from TILDA who met the final inclusion criteria for SPRINT using data from the first wave of TILDA which was completed on July 31, 2011. Between Feb. 1, 2012, and March 31, 2013 (wave 2), and March 1, 2014, and Dec. 31, 2015 (wave 3), follow-up outcomes were reported. To assess falls and syncope, participants or a proxy reported on if they had fallen or had syncope since their last interview and if so, whether the event resulted in an injury that required medical treatment.

Results showed that TILDA participants were more likely to have orthostatic hypertension at baseline than SPRINT participants (12.3% vs. 9.4%); however, SPRINT participants were more likely to have a history of CVD (23.4% vs. 17.7%), as well as higher rates of aspirin (58% vs. 39.3%) and statin use (52.8% vs. 39.1%). Of the participants in the TILDA study, 27.3% reported an injurious fall and 13.3% reported syncope, while only 5.5% of participants in the SPRINT study reported injurious falls and 2.4% reported syncope.

“In a community-based prospective cohort with contemporaneous follow-up of comparable duration (TILDA), participants 75 years of age or older who met inclusion criteria for SPRINT had rates of injurious falls and syncope approximately 5-fold higher than the standard care group in SPRINT,” Sexton and colleagues concluded. “Given the high baseline rates of falls and syncope, any increase in these rates due to intensive treatment of hypertension could result in harm.” – by Alaina Tedesco

Disclosure: The study was funded by the Health Research Board of Ireland.

 

Rates of injurious falls and syncope were approximately five times higher in older adults who met inclusion criteria for the Systolic Blood Pressure Intervention Trial compared with adults in the standard care group in the trial, according to a research letter published in JAMA Internal Medicine. Researchers warned that these risks must be considered before starting more intensive BP lowering regimens in this patient population.

“The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that treating adults 75 years of age or older with hypertension to reach a systolic blood pressure target of less than 120 mm Hg compared with a systolic blood pressure target of less than 140 mm Hg reduced the numbers of cardiovascular events and death without a significant increase in the number of injurious falls or syncope,” Donal J. Sexton, BSc, MD, from Trinity College Dublin in Ireland, and colleagues wrote. “However, prior to the adoption of an intensive strategy to lower systolic blood pressure in the oldest segment of the population, it is prudent to determine if individuals meeting inclusion criteria for SPRINT outside the clinical trial context are similar to trial participants, especially with regard to risk for adverse outcomes.”

Sexton and colleagues compared the baseline rates of injurious falls and syncope between community-dwelling adults aged 50 years and older from the Irish Longitudinal Study on Ageing (TILDA) and the standard care group of SPRINT. Participants in the TILDA study (n = 407) completed an in-home interview, a self-reported questionnaire (n=8,175) and a comprehensive health assessment (n=5,751). TILDA participants had a mean follow-up of 3.4 years, whereas SPRINT participants had a median follow-up of 3.4 years. All participants in the TILDA study were white, whereas 74.8% of participants in the SPRINT study were white. The researchers identified participants from TILDA who met the final inclusion criteria for SPRINT using data from the first wave of TILDA which was completed on July 31, 2011. Between Feb. 1, 2012, and March 31, 2013 (wave 2), and March 1, 2014, and Dec. 31, 2015 (wave 3), follow-up outcomes were reported. To assess falls and syncope, participants or a proxy reported on if they had fallen or had syncope since their last interview and if so, whether the event resulted in an injury that required medical treatment.

Results showed that TILDA participants were more likely to have orthostatic hypertension at baseline than SPRINT participants (12.3% vs. 9.4%); however, SPRINT participants were more likely to have a history of CVD (23.4% vs. 17.7%), as well as higher rates of aspirin (58% vs. 39.3%) and statin use (52.8% vs. 39.1%). Of the participants in the TILDA study, 27.3% reported an injurious fall and 13.3% reported syncope, while only 5.5% of participants in the SPRINT study reported injurious falls and 2.4% reported syncope.

“In a community-based prospective cohort with contemporaneous follow-up of comparable duration (TILDA), participants 75 years of age or older who met inclusion criteria for SPRINT had rates of injurious falls and syncope approximately 5-fold higher than the standard care group in SPRINT,” Sexton and colleagues concluded. “Given the high baseline rates of falls and syncope, any increase in these rates due to intensive treatment of hypertension could result in harm.” – by Alaina Tedesco

Disclosure: The study was funded by the Health Research Board of Ireland.