Role of Hyponatremia and Antihypertensives in Falls

doi:10.21203/rs.3.rs-5011611/v1

Falls in older adults represent a significant public health concern. Specific drug categories represent a significant risk factor for falls, yet there is a paucity of awareness regarding this issue. The use of diuretics in the treatment of hypertension has been associated with an increased risk of complications related to electrolyte imbalance. The objective of this study was to evaluate the role of hyponatremia and antihypertensives in patients who have experienced a fall.

Methods: The study included a total of 322 patients who had been admitted to the hospital with a diagnosis of fall-related injuries. At the time of hospital admission, the following data were recorded: age, gender, presence of disease, medications, presence of fracture, and laboratory values. Two groups, with and without hyponatremia, were compared. A p-value of less than 0.05 was considered statistically significant.

Results: The mean age of the participants was 73.28 years (±14.26), and 60.2 % were female. The use of antihypertensive drugs such as hydrochlorothiazide (HCT) (p=.037), angiotensin-converting enzyme inhibitor (ACE) (p=.045), beta-blocker (p=.041) and ACE+HCT (p=.046) was significantly higher in the group with Na≤135mEq/L than in the group with Na≥136mEq/L. Logistic regression analysis showed that hyponatremia was 2.2 times and female gender was 1.9 times more effective in the occurrence of fracture, furosemide use was 2.2 times, and SSRI use was 1.8 times more effective in the development of hyponatremia.

Conclusion: Careful use of antihypertensives that cause hyponatremia in older adults will be effective in preventing falls and their complications.

Geriatrics & Gerontology

Falls

hyponatremia

furosemide

thiazide diuretics

beta blocker

Aim: Role of hyponatremia in falls

Findings: Logistic regression analysis showed that hyponatremia was 2.2 times and female gender was 1.9 times more effective in the occurrence of fracture, furosemide use was 2.2 times, and SSRI use was 1.8 times more effective in the development of hyponatremia.

Message: Hyponatremia is a preventable risk factor in falls.

Falls are a prevalent phenomenon among the elderly population, with a detrimental impact on their quality of life. The complications associated with this condition represent a significant public health concern with an associated economic burden [1, 2]. The term "fall" is defined as "the immobilization of an individual at a level lower than the current level without any compelling force, stroke, or syncope" [3]. It has been demonstrated that 27% of individuals aged 65 and above experience at least one fall per year, with 15% experiencing multiple falls. As indicated by the World Health Organization, the mortality rate associated with falls is notably elevated among individuals aged 60 and above [4]. The occurrence of falls can be attributed to external factors such as the presence of a slippery floor surface and inadequate lighting. Internal factors, including advanced age, physiological changes, comorbidities, and the medications used, represent significant risk factors for falls [5]. The cessation of these pharmaceutical agents represents an efficacious strategy for the prevention of falls. The impact of pharmaceuticals on the occurrence of falls is well documented. It would be beneficial to increase awareness among physicians and the elderly patient group of the factors that contribute to falls.

Hyponatremia is defined as a serum sodium concentration below 135 mEq/L. It is typically precipitated by an inability to excrete water in a normal manner. In the elderly, changes in renal excretory function should be taken into consideration. The effects of diuretics, which are frequently used among antihypertensive drugs, on hyponatremia and falls have been reported in the literature [6, 7].

The presence of Hyponatremia has significant adverse consequences for individuals who experience falls. It has been reported that the risk of non-vertebral fracture increased by a factor of 1.4, and the risk of hip fracture increased by a factor of 1.8 in these patients [8, 9]. Falls are a multifactorial phenomenon akin to osteoporosis and fractures [10, 11]. Falls result in a range of adverse outcomes, including fractures, intracerebral haemorrhages, and mortality, with an estimated incidence of approximately 20%.

The objective of this study was to enhance awareness by examining the impact of Hyponatremia and antihypertensive medications on the incidence of falls and the underlying causal factors.

Material and methods: A total of 544 cases admitted to the hospital between Jan 1, 2018, and Dec 31, 2023, were included in the study. A total of 96 children under the age of 18, 62 cerebrovascular events, 56 falls from height, and eight cases with a diagnosis of hyponatremia were excluded from the study. The remaining 322 cases who fell in the same plane were subjected to further analysis. At the time of hospital admission, the following data were recorded: age, gender, presence of comorbidities, current medications (for a period of at least three months), and the location of any fractures. Laboratory values pertaining to hemoglobin, glucose, sodium, potassium, calcium, alkaline phosphatase, albumin, uric acid, creatinine, and systolic and diastolic blood pressures were recorded at the time of admission. The participants were divided into two groups: a control group with serum sodium levels above 136 mEq/L and a study group with serum sodium levels below 135 mEq/L. The two groups were then compared in terms of their respective laboratory results, the diseases and medications they were taking, and whether or not they had sustained any fractures.

The study was conducted on the basis of the decision of the Ufuk University Non-Interventional Clinical Research Evaluation Ethics Committee, dated Jun 7, 2024 and numbered 12024861-100.

Statistical Analysis

Analyses were conducted using Statistical Package for Windows 22.0 version (IBM SPSS Statistic, Armonk, NY, IBM Corp. 2013). Categorical variables were presented as frequency (n) and percentage (%). The conformity of continuous variables to normal distribution was tested with Skewness and Kurtosis and expressed as arithmetic mean standard deviation values. Values that do not show normal distribution are presented as median and interquartile range. The evaluation of categorical variables, such as the diseases and medications used between groups, was conducted using the chi-square test. A logistic regression analysis was employed to evaluate the impact of drugs affecting hyponatremia and factors leading to fracture formation.

The mean age of the 322 patients who participated in the study was 73.28 years (standard deviation ± 14.26), with 60.2% of the cohort comprising female participants. Table 1 presents the demographic and laboratory results, as well as a comparison of the data between the group with sodium levels below 135 mEq/L and the group with sodium levels above 136 mEq/L. No significant difference was observed between the two groups with regard to gender. Significant differences were observed in age (p = .000), glucose (p = .000), and creatinine (p = .000) between the two groups. These were higher in the group with Na ≤ 135mEq/L. Conversely, calcium (p = .018), albumin (p = .001), and hemoglobin (p = .000) were significantly lower in this group. No significant differences were observed in the levels of potassium, alkaline phosphatase, uric acid, and blood pressure between the two groups.

The prevalence of hypertension (p = .002), diabetes mellitus (p = .001), coronary artery disease (p = .009), and fractures (p = .004) was significantly higher in the Na ≤ 135mEq/L group than in the Na ≥ 136mEq/L group (Table 2). The distribution of fractures was as follows: 52.67% femoral neck, 5.35% vertebrae, and 40.98% other sites. The prevalence of fractures was significantly higher in females (40.2%) compared to males (26.6%), with an odds ratio of 1.7 (p = .012).

The use of antihypertensive drugs such as hydrochlorothiazide (HCT) (p = .037), angiotensin-converting enzyme inhibitor (ACE) (p = .045), beta-blocker (p = .041) and ACE + HCT (p = .046) was significantly higher in the group with Na ≤ 135mEq/L compared to the group with Na ≥ 136mEq/L (Table 3).

In multivariate logistic regression analysis, gender (OR 1.91, 95% Cl:1.134–3.236, p = .015), hyponatremia (OR 2.26, 95% Cl:1.363–3.777, p = .002), diabetes (OR .44, 95% Cl:.249-.802, p = .007) and chronic obstructive pulmonary disease (OR .15, 95% Cl:.033-.749, p=. In multivariate logistic regression analysis, gender (OR 1.91, 95% Cl:1.134–3.236, p=. 015), hyponatremia (OR 2.26, 95% Cl:1.363–3.777, p = .002), diabetes (OR .44, 95% Cl:.249-.802, p = .007) and chronic obstructive pulmonary disease (OR .15, 95% Cl:.033-.749, p = .020) were found to be significantly effective (R² .122).

Furosemide (OR 2.27, 95% Cl:.983-5.256, p = .055), beta-blocker (OR 1.65, 95% Cl: 1.015–2.705, p = .043), and selective serotonin reuptake inhibitor (OR 1.82, 95% Cl: 1.019–3.276, p = .043) were found to be effective in multivariate logistic regression analysis on the development of hyponatremia.

The principal objective of this study was to assess the relationship between Hyponatremia and falls and to determine the role of antihypertensive drugs in this context. The results of the multivariate regression analysis demonstrated that hyponatremia was a significant predictor of falls, while antihypertensive drugs were identified as a key factor in the management of hyponatremia. In light of the fact that falls in older adults represent a significant public health concern, it is crucial to highlight this issue in the context of antihypertensive drug prescription.

The mean age of patients presenting with a complaint of falls was 73.28 (± 14.16) years, with 60.2% being female. The prevalence of female patients and those in the older age bracket was in accordance with the findings of previous studies. Gerstle et al. [12] reported that the risk of falls was higher in the elderly group in their study of step transition in young and elderly people with and without a history of falls. Similarly, Scott et al. observed that fall injuries were least prevalent in young male production workers in their age-, gender-, and sector-based evaluation of falls at the same level in workplaces [13]. The data from the studies mentioned above were found to be consistent with the current study in terms of age and gender.

In a systematic meta-analysis of the risk of falls in the elderly population conducted by Xu et al., hypertension, diabetes, heart disease, stroke, weakness, and previous fall history were identified as factors that increase the risk of falls [14]. In the present study, a significant association was observed between hypertension, diabetes, and coronary artery disease and a sodium level below 135mEq/L, as compared to a sodium level above 136mEq/L. Additionally, the incidence of fracture was found to be significantly higher in the former group. These findings were in alignment with the results of the systematic meta-analysis.

Hypertension represents the primary cause of mortality and morbidity on a global scale, affecting one in four adults. As the global population continues to age and the age-standardized prevalence of hypertension increases by 10%, it is estimated that hypertension is responsible for 9.4 million deaths annually. The first-line pharmacological agents for the treatment of hypertension are diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel blockers. Hyponatremia has the potential to be a life-threatening adverse effect in elderly patients undergoing treatment with thiazide-type and analogous diuretics [15]. The present study revealed a significantly higher prevalence of hypertension in the group with Hyponatremia compared to the group without Hyponatremia. Furthermore, the utilization of hydrochlorothiazide, angiotensin-converting enzyme inhibitors, beta-blockers, and hydrochlorothiazide ACE combinations was markedly elevated in the cohort exhibiting Hyponatremia. Falhammer et al. evaluated patients who had been administered calcium channel blockers, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers while in hospital with a diagnosis of Hyponatremia. This was carried out in order to ascertain the efficacy of these drugs in patients with Hyponatremia when used in conjunction with matched models [16]. The researchers observed that the risk of hospitalization due to Hyponatremia was moderately elevated in patients who had recently initiated treatment with these medications. In this study, furosemide, SSRI, and beta-blocker were found to be effective in preventing the development of Hyponatremia in logistic regression analysis, with a relative risk of 2.2, 1.8, and 1.6, respectively.

It is established that polypharmacy is a significant risk factor for adverse drug reactions, hospitalization, and falls in elderly patients. Masumato et al. [17] reported that the use of multiple drugs was effective in preventing falls over a one-year prospective follow-up period, as evidenced by a reduction in the incidence of falls, emergency room visits, and hospitalizations in patients over the age of 65. In the present study, it was observed that the number of medications used exceeded three and that dual and triple antihypertensive agents were employed in patients aged 65 years and above. Juraschek et al. [18] reported in the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) clinical trial subpopulation that the relative risk of falls, fainting, and orthostatic hypotension increased at the age of 65 years and older. Furthermore, they observed that amlodipine increased the risk of falls compared to chlorthalidone in the first year. The present study has revealed that among antihypertensive drugs, furosemide, beta-blockers, and SSRIs have been identified as potential contributors to falls via Hyponatremia. It is possible that differences may be observed between selective and non-selective beta blockers. In a previous study, Wedman et al. [19] demonstrated that a number of pharmacological agents, including SSRIs, angiotensin-converting enzyme inhibitors, sartans, and long-acting benzodiazepines, were effective in reducing the incidence of falls in inpatients. Ruzicha et al. [20] reported that significant clinical symptoms, including Hyponatremia, delirium, and falls, were adverse effects of thiazide diuretics. Ravioli et al. [21] recommended that the use of thiazides should be questioned in elderly individuals, women, and those who are prone to falling. In the present study, a significantly higher prevalence of thiazide use was observed among individuals with Hyponatremia. Our findings are in accordance with those of the studies mentioned above.

Tachi et al. reported that hyponatremia and hypokalemia increased the risk of falls in individuals over 65 years of age [22]. They divided the patients hospitalized for one year into fall and non-fall groups and evaluated them with single and multiple regression analysis. In our study, hyponatremia and female gender had a higher rate of post-fall fracture in multiple regression analysis. Our study consisted of patients who presented with a fall. In the study by Aranda-Gallardo et al., patients who fell in hospital over two years were compared with two equivalent control cases. They found that there was a significant relationship between hyponatremia and falls and that the consequences led to more serious complications [23]. In this study, hyponatremia was found to have a significant effect on fracture occurrence in logistic regression analysis.

This study has several limitations. This study is limited by its retrospective design and single-center setting, which may limit the generalizability of the findings. Additionally, the sample size was relatively small.

Hyponatremia affects approximately 5% of adults and 35% of hospitalized patients and is known to be associated with falls. Even moderate hyponatremia is associated with falls in the elderly. In the controls of elderly individuals using antihypertensive drugs, physicians should be more careful when serum sodium values are 135mEq/L and below. Especially in elderly and high-risk patients with multiple drug use, follow-up should be done more carefully by remembering the complications that may develop. Thus, the individual can be warned about the possibility of a fall, and preventive measures can be implemented.

Competing Interests:

there is no conflict of interest.

Ethical approval:

The study was conducted on the basis of the decision of the Ufuk University Non-Interventional Clinical Research Evaluation Ethics Committee, dated Jun 7, 2024 and numbered 12024861-100. In the context of a retrospective study, it was not appropriate to obtain consent from the patients.

Informed consent:

In the context of a retrospective study, it was not appropriate to obtain consent from the patients. What was available was confirmed verbally.

Funding:

The authors did not receive support from any organization for the submitted work.

-Seppala LJ, Velde NV, Masud T, Blain H, Petrovic M et al (2019) EuGMS Task and Finish Increasing Drugs (FRIDs) Position on Knowledge Dissemination, Management, and Future Research. Drugs& Aging 36:299–307. https://doi:10.1007/s40266-018-0622-7
-Kobayashi K, Imagama S, Inagaki Y, Suzuki Y, Ando K, Nishida Y, Nagao Y, Ishiguro N (2017) Incidence and characteristics of accidental falls in hospitalizations. Nagoya J Med Sci 9:291–298. https://doi.org/10.18999/nagjms.79.3.291
-World Health Organization (2018) Falls. Fact sheet no., 344. Retrieved from http://www.who.int/mediacentre/factsheets/fs344/es/
-Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ (2007) Will my patient fall? JAMA 297(1):77–86. https://doi.org/10.1001/jama.297.1
-Deandrea S, Bravi F, Lucenteforte E, Vecchia CL, Negri E (2013) Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr 56(3):407–415. https://doi.org/10.1016/j.archer.2012.12.006
-Horacio JA, Tucker BM, Madias NE (2022) Diagnosis and Management of Hyponatremia. JAMA 328(3):280–291. https://doi:10.1001/jama.2022.11176
-Hyohdoh Y, Hiyama M, Hatakeyama Y, Okuhara Y (2024) Effect of mild hyponatremia on in-hospital falls of elderly hospitalized patients: A retrospective, cohort study. Arch Gerontol Geriatr. ; 118:105315. https://doi.10.1016/j.archger.2023.105315
-Hoorn EJ, Rivadeneira F, van Meurs JBJ, Ziere G, Stricker BHC et al (2011) Mild hyponatremia as a risk factor for fractures. The Rotterdam study. J Bone Miner Res 26(8):1822–1828. https://doi.org/10.1002/jbmr.380
-Ayus JC, Fuentes NA, Negri AL, Moritz ML, Giunta DH, Kalantar-Zadeh K et al (2016) Mild prolonged chronic hyponatremia and risk of hip fracture in the elderly. Nephrol Dial Transpl 31(10):1662–1669. https://doi.org/10.1093/ndt/gfw029
-Fratangelo L, Nguyen S, D’Amelio P (2023) Hyponatremia and aging-related diseases:key player or innocent bystander? A systematic review. Syst Rev 12(1):84. https://doi:10.1186/s13643-023-02246-w
-Kinsella S, Moran S, Sullivan MO, Molloy MG, Eustace JA (2010) Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol 5(2):275–280. https://doi.org/10.2215/CJN.06120809
-Gerstle EE, O'Connor K, Keenan KG, Slavens BA, Cobb SC (2021) The influence of age and fall history on single transition step kinematics. Clin Biomech 89:105456. https://doi:10.1016/j.clinbiomech.2021.105456
-Scott KA, Fisher GG, Barón AE, Tompa E, Stallones L, DiGuiseppi C (2018) Same-level fall injuries in US workplaces by age group, gender, and industry. Am J Ind Med 61(2):111–119. https://doi:10.1002/ajim.22796Epub 2017 Nov 30
-Xu Q, Ou X, Li J (2022) The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health 17:10902599. https://doi:10.3389/fpubh.2022.902599
-Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R et al (2018) Hypertens Nat Rev Dis Primers 4:18014. https://doi:10.1038/nrdp.2018.14
-Falhammar H, Skov J, Calissendorff J, Nathanson D, Lindh JD, Mannheimer B (2020) Associations Between Antihypertensive Medications and Severe Hyponatremia: A Swedish Population–Based Case–Control Study. J Clin Endocrinol Metab 105(10):e3696–e3705. https://doi:10.1210/clinem/dgaa194
-Masumoto S, Sato M, Maeno T, Ichinohe Y, Maeno T (2018) Potentially inappropriate medications with polypharmacy increase the risk of falls in older Japanese patients: 1-year prospective cohort study. Geriatr Gerontol Int 18(7):1064–1070. https://doi:10.1111/ggi.13307
-Juraschek S, Simpson LM, Davis BR, Beach JL, Ishak A, Mukamal KJ (2019) Effects of Antihypertensive Class on Falls, Syncope, and Orthostatic Hypotension in Older Adults: The ALLHAT Trial. Hypertension 74(4):1033–1040. https://doi:10.1161/HYPERTENSIONAHA.119.13445
-Wedmann F, Himmel W, Nau R (2019) Medication and medical diagnosis as risk factors for falls in order hospitalized patients. Eur J Clin Pharmacol 75(8):117–1124. https://doi:10.1007/s00228-019-02669-3
-Ruzicha M, McCormick B, Magner P, Ramsay T, Edwards C et al (2018) eCollection. Thiazide diuretic-caused hyponatremia in the elderly hypertensive: will a bottle of Nepro a day keep hyponatremia and the doctor away? Study protocol for a proof-of-concept feasibility trial. Pilot Feasibility Stud 2018:4:71. https://doi:10.1186/s40814-018-0263-y
-Ravioli S, Bahmad S, Funk GC, Schwarz C, Exadaktylos A, Lindner G (2021) Risk of Electrolyte Disorders, Syncope, and Falls in Patients Taking Thiazide Diuretics: Results of a Cross Sectional Study. Am J Med 134(9):1148–1154. https://doi:10.1016/j.amjmed.2021.04.007.Epub 2021 May 8
-Tachi T, Yokoi T, Goto C, Umeda M, Noguchi Y et al (2015) Hyponatremia and hypokalemia as risk factors for falls. Eur J Clin Nutr 69(2):205–210. https:// 10.1038/ejcn.2014.195.Epub 2014 Sep 17
-Aranda-Gallardo M, Gonzalez-Lozano A, Ona-Gil JI, Morales-Asencio JM, Mora-Banderas A, Canca-Sanchez JC (2022) Relation between hyponatremia and falls by acute hospitalized patients: A case-control study. J Clin Nurs 31:958–966. https://doi:10.1111/jocn.15952

Table 1. Comparison of group data with and without hyponatremia

Parameters	Total n=322	Na≤135 n=124	Na≥136 n=198	t, z, x²	p
Gender % Female Male	60.2 39.8	64.5 35.5	57.6 42.4	1.534	.216
Age (year)	73.28±14.16	77.25±10.31	70.80±15.23	4.06	.000
Glucose^b (mg/dL)	106(34.25)	115(51.5)	102(29)	-3.55	.000
Sodium (mmol/L)	135.2±6	129.12±5.12	139±2.03	-24.41	.000
Potassium(mmol/L)	4.05±.47	4.15±.56	4.05±.41	1.9	.058
Calcium (mg/dL)	8.7±.66	8.66±.64	8.84±.67	-2.38	.018
ALP^b(U/L)	74(36)	74(35)	73.5(38)	-.34	.733
Albumin (g/dL)	3.6±.55	3.47±.60	3.68±.50	-3.38	.001
Uric acid (mg/dL)	5.65±2.01	5.53±2.09	5.74±1.96	-.74	.460
Creatinine (mg/dL)	0.89(.41)	1.00(.42)	.87(.32)	-3.48	.000
Hemoglobin	12.66±2.07	12.1±1.81	13±2.15	3.92	.000
Systolic BP (mmHg)	130±19.37	131.09±21.93	129.51±17.61	.71	.475
Diastolic BP^b (mmHg)	82.07(128.13)	80(15)	80(10)	-.88	.377
^aMean±sd, ^b Median(IQR), ALP: Alkaline phosphatase, BP:Blood pressure

Table 2. Group co-morbid diseases with and without hyponatremia

Diseases %

Na ≤135

Na≥136

X²

p

Hypertension (-)

(+)

26.6

73.4

43.4

56.6

9.26

.002

Diabetes Mellitus (-)

(+)

58.9

41.1

76.3

23.7

10.89

.001

Coronary Artery Disease (-)

(+)

60.5

39.5

74.2

25.8

6.74

.009

Heart Failure (-)

(+)

87.1

12.9

90,9

9.1

.804

.370

Chronic Kidney Disease (-)

(+)

95.2

4.8

97

3

.282

.547

Chronic Obstructive (-) Pulmonary Disease (+)

93.5

6.5

94.4

5.6

.008

.929

Demans (-)

(+)

94.4

5.6

95.5

4.5

.032

.858

Fracture (-)

(+)

55.6

44.4

71.2

28.8

8.14

.004

Table 3. Comparison of antihypertensive drugs in the group with and without hyponatremia

Medicines (%)

Na≤135

Na≥136

X²

p

Hydrochlorothiazide (-)

(+)

66.1

33.9

76.8

23.2

4.345

.037

Angiotensin Converting Enzyme Inhibitor (-)

(+)

43.5

56.5

55.1

44.9

4.036

.045

Beta blocker (-)

(+)

61.3

38.7

72.2

27.8

4.188

.041

Calcium Channel Blocker (-)

(+)

78.2

21.8

80.8

19.2

.316

.574

Selective Serotonin Reuptake Inhibitor (-)

(+)

75.8

24.2

83.3

16.7

2.287

.098

Hydrochlorothiazide ACE Combination (-)

(+)

67.7

32.3

77.8

22.2

3.983

.046

Furosemide (-)

(+)

88.7

11.3

94.4

5.6

2.747

.097

Table 4. Logistic regression of fracture formation factors

Fracture	B	p	Exp(B)	95% C.I.for EXP(B)
Nagelkerke R .122	B	p	Exp(B)	Lower	Upper
Gender	.650	.015	1.916	1.134	3.236
Hyponatremia	.819	.002	2.269	1.363	3.777
Hypertension	.082	.761	1.085	.642	1.835
Diabetes Mellitus	-.806	.007	.447	.249	.802
Coronary Artery Disease	.017	.953	1.017	.582	1.775
Heart Failure	-.210	.636	.811	.340	1.934
Chronic Kidney Disease	.815	.212	2.259	.628	8.135
Chronic Obstructive Pulmonary Disease	-1.848	.020	.157	.033	.749
Dementia	-.270	.633	.763	.252	2.314

Table 5. Logistic regression analysis of the effect of drugs on hyponatremia

Hyponatremia Nagelkerke R .072	B	p	Exp(B)	95% C.I.for EXP(B)
Hyponatremia Nagelkerke R .072	B	p	Exp(B)	Lower	Upper
furosemide	.821	.055	2.273	.983	5.256
Hydrochlorothiazide ACE Combination	-.623	.561	.536	.065	4.391
Hydrochlorothiazide	.906	.381	2.476	.326	18.796
Angiotensin Converting Enzyme Inhibitor	.449	.134	1.567	.871	2.820
Beta Blocker	.505	.043	1.657	1.015	2.705
Calcium Channel Blocker	.062	.834	1.064	.597	1.896
Selective Serotonin Reuptake Inhibitor	.603	.043	1.827	1.019	3.276

The authors declare no competing interests.

Role of Hyponatremia and Antihypertensives in Falls

Status:

Version 1

Abstract

Key summary points

Introduction

Statistical Analysis

Results

Discussion

Limitations

Conclusion

Declarations

Funding:

References

Tables

Additional Declarations

Status:

Version 1