Episode Description
🧠 Clinical Context:
Nursing home residents are fragile fall-prone patients.
Starting a new antihypertensive could trigger orthostasis → serious fractures.
🧪 Study – VA Nursing Home Cohort:
13,000+ residents tracked from 2006–2019, mean age ~78.
Examined fracture risk 30 days after starting an antihypertensive.
Fractures studied: Pelvic, hip (requiring surgery), humerus, radius, ulna.
📈 Outcomes:
New antihypertensive initiated → 4.5 serious falls per 100 person-years.
No med change → 2.2 events per 100 person-years.
That’s >2x risk with a new med.
🩺 Clinical Tips:
Orthostatic BP check should be done 3–6 minutes after standing (not just 1–2 min).
Median best time: 4.5 minutes.
Use shared decision-making: Is the BP goal worth a possible hip fracture?
Consider deprescribing or "start low, go slow" approach in long-term care.