Takeaway
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).
Limitations
Heterogeneity among included studies.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Sarfaroj Khan. Association Between Antihypertensive Treatment and Specific Adverse Events - Medscape - Feb 23, 2021.
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