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. 2023 Sep 1;52(9):afad177.
doi: 10.1093/ageing/afad177.

Risk of adverse events following the initiation of antihypertensives in older people with complex health needs: a self-controlled case series in the United Kingdom

Annika M Jödicke  1 , Eng Hooi Tan  1 , Danielle E Robinson  1 , Antonella Delmestri  1 , Daniel Prieto-Alhambra  1   2
Affiliations

Risk of adverse events following the initiation of antihypertensives in older people with complex health needs: a self-controlled case series in the United Kingdom

Annika M Jödicke et al. Age Ageing. .

Abstract

Background: We assessed the risk of adverse events-severe acute kidney injury (AKI), falls and fractures-associated with use of antihypertensives in older patients with complex health needs (CHN).

Setting: UK primary care linked to inpatient and mortality records.

Methods: The source population comprised patients aged >65, with ≥1 year of registration and unexposed to antihypertensives in the year before study start. We identified three cohorts of patients with CHN, namely, unplanned hospitalisations, frailty (electronic frailty index deficit count ≥3) and polypharmacy (prescription of ≥10 medicines). Patients in any of these cohorts were included in the CHN cohort. We conducted self-controlled case series for each cohort and outcome (AKI, falls, fractures). Incidence rate ratios (IRRs) were estimated by dividing event rates (i) during overall antihypertensive exposed patient-time over unexposed patient-time; and (ii) in the first 30 days after treatment initiation over unexposed patient-time.

Results: Among 42,483 patients in the CHN cohort, 7,240, 5,164 and 450 individuals had falls, fractures or AKI, respectively. We observed an increased risk for AKI associated with exposure to antihypertensives across all cohorts (CHN: IRR 2.36 [95% CI: 1.68-3.31]). In the 30 days post-antihypertensive treatment initiation, a 35-50% increased risk for falls was found across all cohorts and increased fracture risk in the frailty cohort (IRR 1.38 [1.03-1.84]). No increased risk for falls/fractures was associated with continuation of antihypertensive treatment or overall use.

Conclusion: Treatment with antihypertensives in older patients was associated with increased risk of AKI and transiently elevated risk of falls in the 30 days after starting antihypertensive therapy.

Keywords: acute kidney injury; antihypertensives; drug safety; falls; older people; pharmacoepidemiology; self-controlled case series.

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Conflict of interest statement

D.P.-A. receives funding from the UK National Institute for Health and Care Research (NIHR) in the form of a senior research fellowship and from the Oxford NIHR Biomedical Research Centre. His research group has received funding from the European Medicines Agency and Innovative Medicines Initiative. His research group has received research grant/s from Amgen, Chiesi-Taylor, GSK, Novartis and UCB Biopharma. His department has also received advisory or consultancy fees from Amgen, Astellas, Astra Zeneca, Johnson and Johnson, and UCB Biopharma; and speaker fees from Amgen and UCB Biopharma. Janssen and Synapse Management Partners have supported training programmes organised by D.P.-A.’s department and open for external participants organised by his department outside the submitted work. All other authors declare no conflict.

Figures

Figure 1
Figure 1
Study inclusion flowchart. N = number of individuals, CPRD = Clinical Practice Research Datalink, eFI = electronic Frailty Index. Unplanned hospitalisations were defined as unplanned admission via Admitted Patient Care or admissions through the Accident and Emergency department in HES.
Figure 2
Figure 2
SCCS for falls. N = number of events, FU = follow-up in patient years, 95% CI = 95% confidence interval.
Figure 3
Figure 3
SCCS for fractures. N = number of events, FU = follow-up in patient years, 95% CI = 95% confidence interval.
Figure 4
Figure 4
SCCS for AKI. N = number of events, FU = follow-up in patient years, 95% CI = 95% confidence interval.
See this image and copyright information in PMC

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