Risk of fractures in subjects with antihypertensive medications: A nationwide claim study.
BACKGROUND
The effect of antihypertensives on fracture has important clinical implications, since antihypertensives are frequently prescribed with lifelong exposure. This study aimed to compare risk of fracture between antihypertensive medication classes and non-users among adults.


METHODS
Nationwide claim data from January 1, 2007 to December 31, 2011 were analyzed. Among 8,315,709 subjects with antihypertensive prescriptions in nationwide medical claim database in South Korea, 528,522 subjects, who initiated single-drug antihypertensives or non-users, were analyzed. Subjects were classified as non-user, alpha-blocker (AB), angiotensin-converting-enzyme-inhibitor (ACEI), angiotensin-receptor-blocker (ARB), beta-blocker (BB), calcium-channel-blocker (CCB), and diuretic users. Subjects with combination antihypertensive medications were excluded.


RESULTS
A total of 16,805 fracture outcomes were observed during mean follow-up duration of 1.9 years. Fracture rate per 10,000 person-years varied significantly across type of antihypertensives, with ARB having the lowest rate (152.7, 95% confidence interval (CI) 145.4-160.4), and AB having the highest rate (323.7, 95% CI 237.4-441.4). Non-users had fracture rates (152.2, 95% CI 148.7-155.7) similar to ARB users. In models adjusting for age, gender, comorbidity score, diagnosis of diabetes, diagnosis of osteoporosis, osteoporosis treatment, and osteoporosis related diseases, AB users (adjusted hazard ratio (aHR)=2.26), ACEI users (aHR=1.68), diuretic users (aHR=1.45), CCB users (aHR=1.23), and BB users (aHR=1.15) showed significantly increased risk of fractures compared with non-users (P<0.05). Only the fracture risk of ARB users (aHR=1.00, 95% CI 0.95-1.05) was not significantly different from the non-users.


CONCLUSIONS
The use of antihypertensives except for ARB is associated with increased risk of fracture, with ACEI and AB having higher risk among hypertensive adults.
['Choi|Hyung Jin|HJ|', 'Park|Chanmi|C|', 'Lee|Young-Kyun|YK|', 'Ha|Yong-Chan|YC|', 'Jang|Sunmee|S|', 'Shin|Chan Soo|CS|']
D000368:Aged D000369:Aged, 80 and over D000959:Antihypertensive Agents D015331:Cohort Studies D016208:Databases, Factual D005260:Female D005500:Follow-Up Studies D050723:Fractures, Bone D006801:Humans D007345:Insurance Claim Review D008297:Male D008875:Middle Aged D058866:Osteoporotic Fractures D056910:Republic of Korea D012189:Retrospective Studies D012307:Risk Factors
Fracture Antihypertensives Pharmacoepidemiology