Falls, chronic diseases, and drug use in elderly women: Lack of association may be explained

doi:10.1136/bmj.327.7426.1288

BMJ 2003;327:1288 (29 November), doi:10.1136/bmj.327.7426.1288

Letter

Falls, chronic diseases, and drug use in elderly women

Lack of association may be explained

The first 150 words of the full text of this article appear below.

EDITOR—In a cross sectional study reported by Lawlor etal use of cardiovascular drugs was not independently associatedwith a fall.¹ The authors have not, however, addressed certainissues concerning prescribing patterns of these drugs that mayhave influenced this result.

Appropriate prescription of cardiovascular drugs—for example,angiotensin converting enzyme (ACE) inhibitors—may presentwith difficulties. ACE inhibitors improve prognosis of patientswith heart failure,² yet a doctor may decide to exercise cautionin prescribing these drugs to patients with an increased riskof falls because of, for example, aortic stenosis or symptomaticpostural hypotension. Other patients are inappropriately deprivedof ACE inhibitors because of older age³ or unfounded concernsabout adverse effects.⁴ A similar pattern may exist for othercardiovascular drugs—for example, calcium channel blockersor nitrates.

A significant proportion of patients in this study that wereat risk of falls may not have been prescribed cardiovasculardrugs, . . . [Full text of this article]

Elliot F Epstein, specialist registrar in general and geriatric medicine

University Hospital of North Staffordshire, Stoke on Trent, Staffordshire ST4 6QG elliotepstein832@hotmail.com

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