a1 Department of Clinical Geratology, John Radcliffe Hospital, Oxford, UK
There are inadequate data to formulate evidence-based guidelines on cardiovascular medication and falls. A critical systematic review of medication as a risk factor for falls concluded that there was a weak association between drugs that reduce blood pressure and falls. The population studies reviewed, looking for an association between cardiovascular drug usage and falls, consisted of subjects who were much younger and who had a much lower drug burden when compared with the older clinic population. The magnitude of the effect of cardiovascular medications on falls may therefore have been underestimated in these studies.
Two observational studies in falls clinics showed significant reductions in falls and syncope following withdrawal of cardiovascular medication, with improvements in symptoms, in tilt-table parameters predictive of syncope, and in measures of gait and balance.
There are no randomized controlled trials of the effect of cardiovascular drug withdrawal on falls. An expert audience of 200 members attending the 2009 British Geriatrics Society Falls Section Conference held the unanimous opinion that cardiovascular medications were a significant cause of falls in older people.
(Online publication November 19 2010)