# Amlodipine and frusemide: pharmacological factors contributing to increased fall risk in concurrently treated patients – a retrospective cross-sectional study

## TL;DR

This study finds that patients prescribed amlodipine and frusemide have higher fall risk factors, suggesting the need for careful patient assessment.

## Contribution

The study identifies the prevalence of amlodipine and frusemide combination prescriptions and their association with fall risk factors in older patients.

## Key findings

- 18% of patients were prescribed amlodipine and frusemide combination (AFC).
- AFC patients had higher rates of diabetes, anemia, osteoporosis, and more fall risk-inducing drug prescriptions.
- Higher comorbidity scores and more orthostatic hypotension-inducing drugs were significantly associated with AFC prescriptions.

## Abstract

Calcium channel blockers, such as amlodipine, are commonly prescribed for hypertension but can cause peripheral edema, often requiring adjunctive frusemide. Concerns exist regarding the potential increase in fall risk, particularly in older populations. However, few studies have assessed the prevalence of amlodipine and frusemide combination (AFC) prescriptions and their association with fall risk factors.

The aims of this study are to determine the prevalence of AFC prescriptions and evaluate their association with fall risk factors in an outpatient cardiology clinic population.

This retrospective, cross-sectional study included patients aged ≥40 years from Al-Qatif Central Hospital’s outpatient cardiology clinic (January 2021 -December 2022) prescribed amlodipine. Fall risk factors were identified from literature. The Charlson Comorbidity Index (CCI) was used to estimate 1-year mortality risk. The number of prescribed orthostatic hypotension-inducing drugs (OHDs) and fall-risk increasing drugs (FRIDs) was recorded. Binary logistic regression was performed to determine the association between AFC prescriptions and fall risk factors, adjusting for significant covariates. Results are expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI).

Of 3,681 patients, 18%. Were prescribed AFC. AFC patients were older (70 vs. 64 years, P < 0.001), had a higher prevalence of diabetes mellitus (64% vs. 44%, P < 0.001), anemia (55% vs. 32%, P < 0.001), and osteoporosis (51% vs. 28%, P < 0.001), and received more OHDs prescriptions (2.8 vs. 1.3, P < 0.001) compared to non-AFC patients. Higher CCI scores (OR = 1.51, 95% CI 1.41–1.62) and more OHDs prescriptions (OR = 2.5, 95% CI 2.3–2.7) were significantly associated with AFC prescriptions.

AFC prescriptions are prevalent, and patients prescribed AFC have higher prevalence of fall risk factors. Comprehensive patients assessment is essential to minimize fall risk and related complications.