Association of Clinic Blood Pressure and Out-of-Clinic Blood Pressure Difference With Falls Among Older Adults With Hypertension

BACKGROUND: – A barrier to intensification of antihypertensive medication among older adults with hypertension is the perceived risk of falls. Blood pressure (BP) measured in the clinic setting is primarily used to decide whether antihypertensive medication should be intensified. Scarce data exist on whether a lower out-of-clinic BP relative to in-clinic BP is associated with an increased risk of falls among older adults with hypertension. METHODS: – The sample included 630 participants, enrolled from May 2019 to November 2022 from Kaiser Permanente Southern California, who were aged ≥65 years, had hypertension, were taking antihypertensive medication, and had not experienced a serious fall injury since their last clinic visit. The primary exposure was quartiles (Qs) of the difference between clinic systolic BP from the electronic health record and awake systolic BP on ambulatory BP monitoring. The primary outcome was time to the first fall, determined using monthly falls calendars over 12 months of follow-up. RESULTS: – The mean age (SD) was 74.6 (6.2) years with 56.5% female. During follow-up, 240 (38.1%) of the 630 participants fell. After adjusting for demographics, clinical characteristics, and geriatric measures, participants in Q4 (7.2–47.7 mm Hg) versus Q1-Q3 (-56.7 to <7.2 mm Hg) of clinic systolic BP from the electronic health record and awake systolic BP did not have an increased fall risk: adjusted hazard ratio, 0.79 (95% CI, 0.57–1.09). CONCLUSIONS: – There was no evidence of an association of a lower awake systolic BP on ambulatory BP monitoring relative to clinic systolic BP with an increased risk of falls.