Ambulatory blood-pressure monitoring, antihypertensive therapy and the risk of fall injuries in elderly hypertensive patients

Michael Jonas; Rasisa Kazarski; Gil Chemin

doi:10.11909/j.issn.1671-5411.2018.04.007

摘要：Background Fall injuries are common among the elderly.The aim of this study was to investigate whether blood-pressure patterns,as measured by 24-h ambulatory blood pressure monitoring (ABPM),or intensification of antihypertensive therapy following the 24-h ABPM,may be associated with fall injuries in hypertensive elderly patients.Methods In a retrospective study,community-based elderly patients (age ≥ 70 years) who were referred to 24-h ABPM were evaluated for fall injuries within one-year post-ABPM.We compared the clinical characteristics,24-h ABPM patterns and the intensification of hypertensive therapy following 24-h ABPM,between patients with and without a fall injury.Results Overall 1032 hypertensive elderly patients were evaluated.Fifty-five (5.3％) had a fall injury episode in the year following ABPM.Patients with a fall injury were significantly older,and with higher rates of previous falls.Lower 24-h diastolic blood-pressure (67.3 ± 7.6 vs.70.7 ± 8.8 mmHg;P ＜ 0.005) and increased pulse-pressure (74.7 ± 14.3 vs.68.3 ± 13.7 mmHg;P ＜ 0.005),were found in the patients with a fall injury,compared to those without a fall injury.After adjustment for age,gender,diabetes mellitus and previous falls,lower diastolic blood-pressure and increased pulse-pressure were independent predictors of fall injury.Intensification of antihypertensive treatment following the 24-h ABPM was not associated with an increased rate of fall injury.Conclusions Low diastolic blood-pressure and increased pulse-pressure in 24-h ABPM were associated with an increased risk of fall injury in elderly hypertensive patients.Intensification of antihypertensive treatment following 24-h ABPM was not associated with an increased risk of fall injury.