Diabolical Dilemma: High Blood Pressure or Risk of Falls?

“Cookbook medicine” can be deadly! What do I mean by that concept? Many physicians are following “GUIDELINES” set up by professional organizations. The idea seemed good. It was based on the concept of “Evidence Based Medicine” (aka EBM). Most patients want their healthcare professionals to make decisions based on good science rather than gut feelings. The problem with this approach occurs when a physician, nurse practitioner or physician associate just follows a cookbook, instead of treating each patient as an individual, with a story and a great deal of biological individuality. This is especially critical when treating older people with high blood pressure. That’s because some BP drugs increase the risk of falls!

Scary Stats About the Risk of Falls!

An  article in Clinics in Geriatric Medicine, Nov., 2023 offers some startling statistics.

Here is how the authors of this article introduce their analysis:

“Of 4 older adults, 1 will fall each year in the United States. Based on 2020 data from the Centers of Disease Control, about 36 million older adults fall each year, resulting in 32,000 deaths. Emergency departments (ED) see about 3 million older adults for fall-related injuries with falls having the ability to cause serious injury such as catastrophic head injuries and hip fractures. One-third of older fall patients discharged from the ED experience one of these outcomes at 3 months. Between 36% and 50% of patients have an adverse event, such as a recurrent fall, ED revisit, or death within 1 year after a fall. Not only do falls lead to adverse health outcomes and disability, but also substantial economic burdens for the family and health system.”

This article is written from the perspective of emergency medicine experts. They acknowledge that “interventions” to prevent falls can be challenging.

In particular, they note that emergency department (ED) physicians who frequently have to deal with falls in older patients:

“…will be hesitant to change sleep, depression, anxiety, and cardiovascular medications that specialists and primary care physicians have prescribed.”

Such medications increase the risk of falls. But if an ED doctor is “hesitant” to change a medicine that increases the risk of a repeat fall, who will speak up for the patient?

But wait…here is an even more recent article (JAMA, Aug. 25, 2025).

The authors describe the ongoing problem:

“Older adults are at high risk of harm from falls.In addition to causing death and disability, falls can lead to injuries, hospitalizations, and institutionalization. They may also be the presenting symptom of a new or worsening medical condition, potentially marking the beginning of functional decline. Despite advances in the field, including evidence that individualized balance challenging and functional exercises can decrease future risk of falls, falls remain a substantial and growing challenge for older adults, at both an individual and societal level.”

A Story About the Risk of Falls:

When I warn about a risk of falls, it pretty much goes in one ear and out the other. That’s true for most drug side effects. That is why drug companies do not mind listing a whole bunch of adverse drug reactions in television commercials. If read fast while the actors on the screen are having fun with family and friends, most people ignore warnings about heart attacks, strokes, cancer or death.

That is why we encourage our readers to share their personal experiences with medications. Nothing reveals the importance of a drug side effect such as a risk of falls like a story:

Q. A few years ago, my cardiologist put me on spironolactone to lower my blood pressure from 140/80. Shortly thereafter, I got up from bed for the bathroom. I blacked out in the bathroom, fell and fractured two vertebrae.

I was given a walker and kept on the spironolactone. Later, I was using the walker to get to the bathroom in the middle of the night. I blacked out again, fell onto the walker and cut both knees. That resulted in a three week stay in a rehab facility.

My cardiologist never mentioned that spironolactone might make me faint or fall. I’m no longer on any BP medication but due to the fractures, I am four inches shorter, and my life has been changed forever.

A. A recent article in JAMA Health Forum (Aug. 8, 2025) points out that older Americans are at high risk for dying from medication-induced falls. In fact, more people die from falls than from breast cancer, prostate cancer or car crashes.

While it is important to control hypertension, overtreatment that causes dizziness or blackouts can be life-threatening. Other drugs that also put older people at risk for falls include anti-anxiety drugs (benzodiazepines), antidepressants and pain relievers including opioids and gabapentinoids (gabapentin and pregabalin). Anyone who feels dizzy or unsteady should ask their primary care provider to review their meds and deprescribe any that are no longer essential.

To learn more about how to lower blood pressure, you may wish to read our eGuide to Blood Pressure Solutions. This online resource can be found under the Health eGuides tab.

Some People are Extremely Vulnerable to a Risk of Falls:

Q. I am a 73 year old retired RN who has been treated for high blood pressure since last August by an internist and a cardiologist. Every prescription they have written has had adverse side effects for me.

Within a week of starting the medication, I become very weak and occasionally very faint. I cannot function.

My blood pressure is neither lower nor higher. I have tried lisinopril, atenolol, losartan (Cozaar), olmesartan (Benicar), amlodipine (Norvasc), nifedipine (Procardia XL), carvedilol (Coreg), diltiazem, ramipril (Altace) and spironolactone (Aldactone). In addition I have been taking HCTZ 12.5 with each of the above. (I was not taking the others together.) Is it really worth taking medication that could make me lose consciousness? That frightens me.

A. Many older people have high blood pressure, and consequently their doctors prescribe medications to lower their pressure and reduce their risks of stroke or heart disease. That certainly is a desirable outcome. But we also hear from many people like yourself who find that the side effects of such medications can be upsetting.

It is not unusual for senior citizens to discover that a drug that can bring their blood pressure down can also make them dizzy or faint, especially upon first standing up from a sitting position or lying down. Because dizziness can lead to falls, and falls can have devastating consequences such as hip fractures or head injuries, we worry about aggressive treatment for hypertension in older patients.

Scientific Support for Caution About a Risk of Falls!

A study found that older people who took anti-hypertensive medicines were more likely to have a serious fall over the course of three years (JAMA Internal Medicine, April, 2014). Those who had already experienced a fall were at double the risk.

The investigators who did the study told reporter Paula Span of The New York Times that older people should determine which is more important to them: avoiding cardiovascular risks or minimizing the risk of falls. Then they should let their doctors know about this preference.

We recommend that people with hypertension discuss this issue with internists and cardiologists. To help you prepare for the conversation, we offer our Guide to Blood Pressure Treatment with a discussion of the pros and cons of many types of medication as well as natural approaches to controlling blood pressure. Our Guide to Drugs and Older People may also be helpful.

If you know senior citizens with hypertension, please share this article with them. We want to help them avoid a risk of falls!