Association Between Antihypertensive Treatment and Specific Adverse Events

Sarfaroj Khan 


February 23, 2021


  • This meta-analysis found no evidence of an association between antihypertensive treatment and falls or fractures.

  • However, there was an association between antihypertensive treatment and potentially both mild (hyperkalaemia and hypotension) and severe adverse events (acute kidney injury [AKI] and syncope).

Why this matters

  • Findings might be used to inform shared decision-making between physicians and patients about initiation and continuation of antihypertensive treatment, especially in those at high risk of harm because of previous adverse events or poor renal function.

Study design

  • Meta-analysis of 58 randomised controlled trials including 280,638 participants with a median follow-up duration of 3 years (interquartile range, 2-4 years).

  • Primary outcome: falls; secondary outcomes: AKI, fractures, gout, hyperkalaemia, hypokalaemia, hypotension and syncope.

  • Funding: Wellcome Trust and Royal Society and others.

Key results

  • No statistically significant association was seen between antihypertensive treatment and risk of:

    • falls (7 studies; risk ratio [RR], 1.05; 95% CI, 0.89-1.24);

    • fractures (5 studies; RR, 0.93; 95% CI, 0.58-1.48); and

    • gout (5 studies; RR, 3.84; 95% CI, 0.95-15.57).

  • Antihypertensive treatment was associated with an increased risk of:

    • AKI (15 studies; RR, 1.18; 95% CI, 1.01-1.39; I2, 48.1%);

    • hyperkalaemia (26 studies; RR, 1.89; 95% CI, 1.56-2.30; I2, 71.8%);

    • hypotension (35 studies; RR, 1.97; 95% CI, 1.67-2.32; I2, 85.1%); and

    • syncope (16 studies; RR, 1.28; 95% CI, 1.03-1.59; I2, 42.9%).

  • Antihypertensive treatment was associated with a lower risk of:

    • all-cause mortality (HR, 0.93; 95% CI, 0.88-0.98; I2, 50.4%);

    • cardiovascular death (HR, 0.92; 95% CI, 0.86-0.99; I2, 54.6%); and

    • stroke (HR, 0.84; 95% CI, 0.76-0.93).

  • Antihypertensive treatment was not significantly associated with myocardial infarction (HR, 0.94; 95% CI, 0.85-1.03).


  • Heterogeneity among included studies.

Albasri A, Hattle M, Koshiaris C, Dunnigan A, Paxton B, Fox SE, Smith M, Archer L, Levis B, Payne RA, Riley RD, Roberts N, Snell KIE, Lay-Flurrie S, Usher-Smith J, Stevens R, Hobbs FDR, McManus RJ, Sheppard JP. Association between antihypertensive treatment and adverse events: systematic review and meta-analysis. BMJ. 2021;372:n189. doi: 10.1136/bmj.n189. PMID: 33568342.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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