{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:06:02Z","timestamp":1792242362182,"version":"4.4.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"Importance<\/jats:title>Limited evidence exists on the association between initiation of antihypertensive medication and risk of fractures in older long-term nursing home residents.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the association between antihypertensive medication initiation and risk of fracture.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a retrospective cohort study using target trial emulation for data derived from 29\u202f648 older long-term care nursing home residents in the Veterans Health Administration (VA) from January 1, 2006, to October 31, 2019. Data were analyzed from December 1, 2021, to November 11, 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Episodes of antihypertensive medication initiation were identified, and eligible initiation episodes were matched with comparable controls who did not initiate therapy.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The primary outcome was nontraumatic fracture of the humerus, hip, pelvis, radius, or ulna within 30 days of antihypertensive medication initiation. Results were computed among subgroups of residents with dementia, across systolic and diastolic blood pressure thresholds of 140 and 80 mm Hg, respectively, and with use of prior antihypertensive therapies. Analyses were adjusted for more than 50 baseline covariates using 1:4 propensity score matching.<\/jats:p><\/jats:sec>Results<\/jats:title>Data from 29\u202f648 individuals were included in this study (mean [SD] age, 78.0 [8.4] years; 28\u202f952 [97.7%] male). In the propensity score\u2013matched cohort of 64\u202f710 residents (mean [SD] age, 77.9 [8.5] years), the incidence rate of fractures per 100 person-years in residents initiating antihypertensive medication was 5.4 compared with 2.2 in the control arm. This finding corresponded to an adjusted hazard ratio (HR) of 2.42 (95% CI, 1.43-4.08) and an adjusted excess risk per 100 person-years of 3.12 (95% CI, 0.95-6.78). Antihypertensive medication initiation was also associated with higher risk of severe falls requiring hospitalizations or emergency department visits (HR, 1.80 [95% CI, 1.53-2.13]) and syncope (HR, 1.69 [95% CI, 1.30-2.19]). The magnitude of fracture risk was numerically higher among subgroups of residents with dementia (HR, 3.28 [95% CI, 1.76-6.10]), systolic blood pressure of 140 mm Hg or higher (HR, 3.12 [95% CI, 1.71-5.69]), diastolic blood pressure of 80 mm Hg or higher (HR, 4.41 [95% CI, 1.67-11.68]), and no recent antihypertensive medication use (HR, 4.77 [95% CI, 1.49-15.32]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Findings indicated that initiation of antihypertensive medication was associated with elevated risks of fractures and falls. These risks were numerically higher among residents with dementia, higher baseline blood pressures values, and no recent antihypertensive medication use. Caution and additional monitoring are advised when initiating antihypertensive medication in this vulnerable population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.0507","type":"journal-article","created":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T15:31:44Z","timestamp":1713799904000},"page":"661","source":"Crossref","is-referenced-by-count":28,"title":["Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents"],"prefix":"10.1001","volume":"184","author":[{"given":"Chintan V.","family":"Dave","sequence":"first","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey"},{"name":"Department of Veterans Affairs-New Jersey Health Care System, East Orange"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongmei","family":"Li","sequence":"additional","affiliation":[{"name":"Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California"},{"name":"Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Steinman","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco"},{"name":"Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California San Francisco, San 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