TOPLINE:

In patients aged 40 years or older with a systolic blood pressure of 130-179 mm Hg, initiating antihypertensive therapy was associated with an increased risk for hospitalisation or death due to falls, hypotension, syncope, and acute kidney injury. Increased risks were noted across subgroups based on sex, ethnicity, and socioeconomic status.

METHODOLOGY:

• Researchers conducted an observational cohort study using retrospective data from primary care from the Clinical Practice Research Datalink Aurum database in England from 1998 to 2018.
• They included data of more than 2.5 million patients aged 40 years or older who had not previously received antihypertensive treatment and had systolic blood pressure readings of 130-179 mm Hg.
• Exposure to treatment was defined as receiving a prescription for any antihypertensive (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, thiazides and thiazide-like diuretics, beta-blockers, alpha-blockers, and others) within 12 months after cohort enrolment; 337,742 patients were included in the exposed group and 2,276,588 in the non-exposed group.
• The main outcome was the first hospitalisation or death due to a fall within 10 years of follow-up; other outcomes were hospitalisation or death due to hypotension, syncope, fracture, or acute kidney injury.
• Cox regression models, adjusted for propensity scores (n = 308,287 in the exposed and non-exposed groups) and including 32 covariates, were developed, and results were stratified by sex, ethnicity (Black, South Asian, mixed or other, and White), and socioeconomic status.

TAKEAWAY:

• Overall, hospitalisation or death due to falls occurred in 4.2% of patients, with 7.1% in the exposed group and 3.8% in the non-exposed group.
• The risk for hospitalisation or death due to falls was elevated in both men and women who received antihypertensive treatment (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.06-1.12 and aHR, 1.10; 95% CI, 1.07-1.12, respectively).
• Elevated risks were also noted for hospitalisation or death due to hypotension (aHR, 1.35; 95% CI, 1.31-1.40), syncope (aHR, 1.21; 95% CI, 1.18-1.25), and acute kidney injury (aHR, 1.42; 95% CI, 1.39-1.46), but no significant association was found for fractures.
• An ethnicity-based analysis revealed higher risks for the primary outcome in Black patients (aHR, 1.32; 95% CI, 1.13-1.53), South Asian patients (aHR, 1.22; 95% CI, 1.05-1.41), patients of mixed or other ethnicity (aHR, 1.47; 95% CI, 1.29-1.66), and White patients (aHR, 1.05; 95% CI, 1.03-1.07). The risk for falls was higher in the least deprived group based on the Index of Multiple Deprivation (aHR, 1.16; 95% CI, 1.12-1.21).

IN PRACTICE:

"These data suggest that no distinction should be made among these groups when considering the harms of antihypertensives in individual treatment decisions in primary care. Nevertheless, our findings must be interpreted with caution because unmeasured confounding cannot be completely ruled out," the authors wrote.

SOURCE:

The study was led by Florien S. van Royen, MD, PhD, of the Department of General Practice and Nursing Science at the University Medical Centre Utrecht, Utrecht University in Utrecht, Netherlands. It was published online on May 14, 2026, in The Lancet Primary Care.

LIMITATIONS:

All classes of antihypertensive drugs were analysed together, and risks for adverse outcomes could have varied by drug class across subgroups stratified by ethnicity and sex. Grouping patients into four ethnicity groups may have oversimplified the results and limited their applicability to other populations. The study lacked data on short-term risks for adverse outcomes or on the development of comorbidities in the first 2-5 years after starting treatment.

DISCLOSURES:

This study received joint funding from the Wellcome Trust and the Royal Society via the Sir Henry Dale Fellowship to an author and from the National Institute for Health and Care Research School for Primary Care Research. Some authors reported receiving full or partial support or travel grants from various sources. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.