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Association of Questionnaire-Assessed Fall Risk With Uncontrolled Blood Pressure and Therapeutic Inertia Among Older
Grant T Hiura1, Talar W Markossian2, Beatrice D Probst1,3
1Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
Journal of Clinical Hypertension (Greenwich, Conn.)
|November 5, 2024
Summary
Perceived fall risk in older adults is associated with higher rates of uncontrolled blood pressure and therapeutic inertia. Addressing fall concerns may improve hypertension management in this population.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Pharmacy
Background:
- Therapeutic inertia (TI), the failure to adjust antihypertensive medication when blood pressure (BP) is uncontrolled, is a significant issue in older adults.
- Advancing age is linked to increased TI, with perceived fall risk potentially contributing to this phenomenon.
Purpose of the Study:
- To investigate the association between assessed fall risk and both uncontrolled BP (≥140/90 mmHg) and TI during primary care visits for patients aged 65 years and older.
- To determine if higher perceived fall risk correlates with a greater likelihood of uncontrolled BP and delayed treatment intensification.
Main Methods:
- A cohort of 13,893 patients (≥65 years) with 41,122 primary care visits were analyzed.
- Fall risk was assessed using a three-question questionnaire administered by trained staff, categorizing patients into low, moderate, and high risk groups.
- Generalized linear mixed-effects models were employed to assess the association of fall risk with uncontrolled BP and TI, adjusting for covariates.
Main Results:
- Higher fall risk (moderate and high) was not significantly associated with an increased odds of uncontrolled BP (OR 0.97 and 0.90, respectively, compared to low risk).
- Conversely, moderate and high fall risk were significantly associated with increased odds of therapeutic inertia during visits with uncontrolled BP (OR 1.16 and 1.30, respectively, compared to low risk).
Conclusions:
- Perceived fall risk severity appears to be a contributing factor to therapeutic inertia in hypertension management among older adults.
- These findings highlight the need to consider patient-perceived risks, such as fall risk, in clinical decision-making for optimizing BP control in the elderly.
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