EvidenceAlerts

Berlowitz DR, Foy C, Conroy M, et al. Impact of Intensive Blood Pressure Therapy on Concern about Falling: Longitudinal Results from the Systolic Blood Pressure Intervention Trial (SPRINT). J Am Geriatr Soc. 2019 Nov 28. doi: 10.1111/jgs.16264. (Original study)
Abstract

OBJECTIVES: Concern about falling is common among older hypertension patients and could impact decisions to intensify blood pressure therapy. Our aim was to determine whether intensive therapy targeting a systolic blood pressure (SBP) of 120 mm Hg is associated with greater changes in concern about falling when compared with standard therapy targeting an SBP of 140 mm Hg.

DESIGN: Subsample analysis of participants randomized to either intensive or standard therapy in the Systolic Blood Pressure Intervention Trial (SPRINT).

SETTING: Approximately 100 outpatient sites.

PARTICIPANTS: A total of 2313 enrollees in SPRINT; participants were all age 50 or older (mean = 69 y) and diagnosed with hypertension.

MEASUREMENTS: Concern about falling was described by the shortened version of the Falls Efficacy Scale International as measured at baseline, 6 months, 1 year, and annually thereafter.

RESULTS: Concern about falling showed a small but significant increase over time among all hypertension patients. No differences were noted, however, among those randomized to intensive vs standard therapy (P = .95). Among participants younger than 75 years, no increase in concern about falling over time was noted, but among participants aged 75 years and older, the mean falls self-efficacy score increased by .3 points per year (P < .0001). No differences were observed between the intensive and standard treatment groups when stratified by age (P = .55).

CONCLUSION: Intensive blood pressure therapy is not associated with increased concern about falling among older hypertension patients healthy enough to participate in SPRINT.

Ratings
Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Internal Medicine 6 / 7
Geriatrics 4 / 7
Cardiology 4 / 7
Comments from MORE raters

Cardiology rater

Since they brought it up, it would have been more relevant to see if actual falls were more common in the intensive treatment group.

Cardiology rater

This article confirms that properly shared decision-making is central in optimizing blood pressure control while accounting for the perceived concerns about risk for falling in elderly patients with hypertension.

Geriatrics rater

I am not satisfied with the wording used in this article where it is the "concern" about falling that is being reported. Patients still had falls - not actually stating why or how all patients fell. Also, there are no measures of postural bp drops, etc, around what happens with intense treatment. It is unclear whether the article is just reporting "patient concerns" versus actual objective findings

Internal Medicine rater

Excellent info on lack of increased falls.
Comments from EvidenceAlerts subscribers

Dr. Martín Plaza (12/21/2019 7:29 AM)

Concern about falling is QUITE different than an actual fall. It's well known that a "concern about falling" appears after a fall. Also known as "post-fall syndrome".

Dr. Samuel Chew (12/18/2019 10:14 AM)

I agree completely with the comments by my Cardiology colleague. It would be much more useful if the researchers use actual falls data instead as an outcome measure. Fear of falling is a surrogate marker that is only positive after recurrent or severe traumatic falls. Patients with this history would be excluded by default from trials targeting intensive BP control in the elderly and very elderly. More data are needed in the sub-group of >75/80 year-olds, especially when it has been suggested that, paradoxically, chronic untreated hypertension or hypertension refractory to anti-hypertensive treatment leads to baro-receptor burnout over time, leading to severe orthostatic hypotension and supine hypertension. It is the former that is then a major cause of injurious and traumatising falls, but it is the latter that attracts most attention and measurement in the very elderly.