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Comment & Response
August 19, 2024

Further Study Needed on Antihypertensive Medications and Fracture Risks—In Reply

Author Affiliations
  • 1Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
  • 2Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
  • 3US Department of Veterans Affairs, New Jersey Health Care System, East Orange
  • 4Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
  • 5Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
JAMA Intern Med. 2024;184(10):1266. doi:10.1001/jamainternmed.2024.3937

In Reply We appreciate the comments in response to our study1 and concur with Liew that there is potential for some antihypertensive agents to unmask preexisting orthostatic hypotension. We acknowledge that the SPRINT trial2 elucidated benefits of intensive blood pressure control but emphasize its limited generalizability to populations absent from the study, notably long-term nursing home residents—a population characterized by higher likelihood of multimorbidity, frailty, and elevated falls and fracture risks. Regarding certain subgroup analyses having wide confidence intervals, we note that the lower bound of the 95% CI for these analyses were consistently well above unity, which is strongly suggestive of an increase in risk of fracture, despite the presence of statistical uncertainty in pinpointing the precise magnitude of this effect size. Regarding corticosteroid use, we find it improbable that the robust and pronounced association observed in our study1 could be nullified by this single variable.

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