When Blood Pressure Treatment Raises the Risk of Falls

For decades, doctors have emphasized the importance of lowering blood pressure to prevent heart attacks and strokes. With good reason! The CDC estimates that: “More than 843,000 Americans die of heart disease or stroke every year—that’s more than 1 in 4 deaths.” But a new study in The Lancet Primary Care (May 14, 2026) suggests that blood pressure treatment raises the risk of falls more than many people realize. In an analysis of more than 2.6 million patients, those prescribed antihypertensive drugs were more likely to be hospitalized—or even die—after a fall compared to those not taking such medications.

This does not mean people should stop their medicines. But it does highlight a problem we have been writing about for years: lowering blood pressure is not risk-free.

“Cookbook Medicine” Can Be Dangerous

What is “Cookbook medicine”? Many clinicians follow guidelines based on “evidence-based medicine.” That sounds reassuring. But when health professionals treat numbers instead of people, problems arise. Computerized logarithms often encourage healthcare professionals to aim for certain goals when it comes to things like cholesterol levels and blood pressure numbers.

Every patient is biologically unique, however. What works well for one person could be dangerous for someone else. That’s especially important when treating high blood pressure, because some medications can lead to dizziness, fainting and instability.

Scary Stats About the Risk of Falls

Falls are not a minor inconvenience. They can be life-changimg!

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

• One in four older adults falls each year in the U.S.
• That equals 36 million falls
• 32,000 people die annually as a result of a fall

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

“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? It has been our experience that emergency physicians may not always communicate with primary care providers (PCPs). As a result, medication changes may not occur in a timely manner.

Here is another article (JAMA, Aug. 25, 2025) on this topic in which 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.”

We Have been Warning About the Risk of Falls for Years

This concern did not suddenly show up in recent years.

A study published in JAMA Internal Medicine (April, 2014) followed nearly 5,000 Medicare beneficiaries for three years:

• Those on multiple blood pressure drugs were at significantly higher risk for serious falls
• Injuries included hip fractures and head trauma
• Patients with prior falls were more than twice as likely to be injured again

In other words, the signal has been there for more than a decade.

A comment in the same medical journal (JAMA Internal Medicine, April, 2014) offers this perspective on that research:

“Findings from several recent studies suggest that antihypertensive medication use may be associated with injurious falls in the elderly…In the primary analysis, exposure to moderate or high doses of any antihypertensive medication was associated with a 30% to 40% increased risk of injurious falls compared with no antihypertensive medication use…These findings add evidence that antihypertensive medications are associated with an elevated risk of injurious falls.

“So how do clinicians reconcile the potential harms and benefits of antihypertensive medications in elderly patients? In the absence of direct data, they should individualize the decision to treat hypertension according to functional status, life expectancy, and preferences of care…When antihypertensive drug treatment is indicated, using the lowest dose possible to achieve a target blood pressure makes good sense. Most important, clinicians should pay greater attention to fall risk in older adults with hypertension in an effort to prevent injurious falls, particularly among adults with a previous injury.”

That is why “cookbook medicine” is unacceptable. In recent years guidelines have encouraged prescribers to aim for blood pressure below 120/80. That may be fine for a younger person in good health. But if prescribing multiple BP meds at higher doses to an older person leads to a fall, the results could be devastating.

Stories Trump Lists of Side Effects

When I warn about a risk of falls, I fear that 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 People’s Pharmacy 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. An 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 the 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.

New Evidence Strengthens our Concerns About a Risk of Falls!

The study published in The Lancet Primary Care (May 14, 2026) is just the latest and largest study. It is hard to dismiss:

• Over 2.6 million patients
• Up to 10 years of follow-up
• Increased risk of:
  • Falls requiring hospitalization
  • Death from falls
  • Hypotension and fainting

Although the “absolute risk” of such complications is “low overall,” they are more likely in frail older adults. The authors point out that:

“…numbers needed to harm were reaching numbers needed to treat.”

In other words, the benefits of treatment were almost equal to the harms of treatment, especially when patients were over 80.

Why Blood Pressure Treatment Can Increase the Risk of Falls

Several mechanisms could be at work:

• Orthostatic hypotension (blood pressure drops when standing suddenly)
• Dizziness or lightheadedness
• Fainting (syncope)
• Medication interactions (polypharmacy)

These effects can be subtle—until they aren’t.

The people who conducted the study in JAMA Internal Medicine, April, 2014 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.

Are You at Risk? Warning Signs to Watch For

Please pay attention to these symptoms:

• Feeling dizzy when standing up quickly
• Lightheadedness after taking medication
• Episodes of fainting or near-fainting
• Unsteadiness while walking
• Needing to grab furniture for balance

A Check for Orthostatic Hypotension

This is a key concern for people on multiple blood pressure meds. Remember, “orthostatic hypotension” means blood pressure falls when standing up quickly.

Here is what the CDC offers healthcare professionals who want to assess patients for this condition:

1. “Have the patient lie down for 5 minutes
2. Measure blood pressure and pulse rate 
3. Have the patient stand
4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes

“A drop in BP of ≥20 mm Hg, or in diastolic BP of ≥10 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.”

Orthostatic hypotension is a red flag for fall risk!

Consider a Balance Assessment

A well-trained physical therapist can evaluate stability using tests such as:

• Timed Up and Go (TUG): How much time does it take to stand up from a chair, walk 10 feet, come back and sit down?
• Standing balance tests: How long can a patient stand on one leg (being careful to support the person in case they become unsteady)
• Gait assessment: What is the stride length, steadiness and walking speed?

Final Words

Lowering blood pressure can reduce the risk of heart attacks and strokes. But research shows that aggressive treatment that leads to unsteadiness or dizziness also has serious risks. The risk of falls has often been under-appreciated.

We have focused on older adults in this article, but some younger people on multiple blood pressure medications may also experience dizziness or orthostatic hypotension. These are not trivial symptoms! They can be warning signs that someone is at risk for a fall.

Medicine is rarely black and white. Lower is not always better and higher is not always safer. The goal is not perfection on an electronic medical record. Cookbook medicine is unacceptable. Every person requires individualized treatment. That means safety, function and quality of life.

Never stop medication on your own! Please discuss side effects with your clinician.

Ask About:

• Dose adjustments
• Medication combinations
• Non-drug approaches

We recommend that people with hypertension discuss the issues raised in this article with physicians, nurse practitioners and physician associates. 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! We welcome your story in the comment section below.