Hypertension treatment has been implicated in falls,
syncope, and
orthostatic hypotension (
OH), common events among older adults. Whether the choice of
antihypertensive agent influences the risk of falls,
syncope, and
OH in older adults is unknown. ALLHAT (
Antihypertensive and
Lipid-Lowering Treatment to Prevent
Heart Attack Trial) was a randomized clinical trial that compared the effects of
hypertension first-step
therapy on fatal
coronary heart disease or nonfatal
myocardial infarction (1994-2002). In a subpopulation of ALLHAT participants, age 65 years and older, we determined the relative risk of falls,
syncope,
OH, or a composite based on Centers for Medicare and Medicaid Services and Veterans Affairs claims, using Cox regression. We also determined the adjusted association of self-reported
atenolol use (ascertained at the 1-month visit for indications other than
hypertension) on outcomes in Cox models adjusted for age, sex, and race. Among 23 964 participants (mean age 69.8±6.8 years, 45% women, 31% non-Hispanic black) followed for a mean of 4.9 years, we identified 267 falls, 755
syncopes, 249
OH, and 1157 composite claims. There were no significant differences in the cumulative incidences of events across randomized drug assignments. However,
amlodipine increased risk of falls during the first year of follow-up compared with
chlorthalidone (hazard ratio [95% CI]: 2.24 [1.06-4.74]; P=0.03) or
lisinopril (hazard ratio [95% CI]: 2.61 [1.03-6.72]; P=0.04).
Atenolol use (N=928) was not associated with any of the 3 individual or composite claims. In older adults, the choice of
antihypertensive agent had no effect on risk of fall,
syncope, or
OH long-term. However,
amlodipine increased risk of falls within 1 year of initiation. These short-term findings require confirmation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.