Association of 3 Different Antihypertensive Medications With Hip and Pelvic Fracture Risk in Older Adults - Review Dr Vivek Baliga

Dr Vivek Baliga, Consultant at Baliga Diagnostics discusses a recent paper.

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OBJECTIVE : To examine whether the use of thiazide diuretics for the treatment of hypertension is associated with reduced fracture risk compared with ACEI and CCB.

Methods:

• The study examined hip and pelvic fracture hospitalizations in ALLHAT participants (> 65 years & from USA only) randomized to chlorthalidone (CH), amlodipine besylate, or lisinopril from 1994 to 1998;
  
• The mean study follow-up was 4.9 years.
  
• Post-trial extended follow-up was conducted till 2006, using passive surveillance via national databases.
  
• MAIN OUTCOMES AND MEASURES Hip and pelvic fracture hospitalizations

 RESULTS:

• Total 22 180 participants (mean age, 70.4  years) were followed for up to 8 years (mean: 4.9  years) during masked therapy.
  
• After trial completion, 16 622 participants  were available were followed for up to 5 additional years (mean total follow-up: 7.8 years). 
  
• Participants in CH group had significantly lower risk of fracture by 21%  vs (amlodipine/lisinopril) on adjusted analyses [0.82 Vs 1.17 per 100 Person years ([HR], 0.79; P = 0.04).
  
• Risk of fracture was significantly lower by 25% in CH group vs lisinopril group (HR, 0.75; P = .04)
  
• No significantly difference in risk of fracture in CH Vs amlodipine group (HR, 0.82; ; P = .17).
• In extended follow-up, cumulative incidence of fractures was nonsignificantly lower in CH group vs (lisinopril or amlodipine) (HR, 0.87; P = .10) and vs each medication separately. 

CONCLUSION:

Elderly hypertensive patients on chlorthalidone (CH) therapy has lower risk of pelvic/hip fracture than those on ACE inhibitors in ALLHAT trial.