ANTIHYPERTENSIVES USE AND AD
Recent reports suggest that antihypertensive (AH) medications may reduce the risk of dementing illnesses. The objectives of this study were to examine the relationship of AH medication use with incidence of Alzheimer’s disease (AD) among the elderly population (age 65 years and older) of Cache County, Utah, and to examine whether the relationship varies with different classes of AH medications. After an initial (wave 1) multistage assessment (1995 through 1997) to identify prevalent cases of dementia, the authors used similar methods 3 years later (wave 2) to identify 104 incident cases of AD among the 3308 survivors. At the baseline assessment, the authors obtained a detailed drug inventory from the study participants. They carried out discrete time survival analyses to examine the association between the use of AH medications (including angiotensin converting enzyme inhibitors, beta-blockers, calcium channel blockers, and diuretics) at baseline with subsequent risk of AD. Results showed that use of any AH medication at baseline was associated with lower incidence of AD (adjusted hazard ratio, 0.64; 95% confidence interval (CI), 0.41-0.98). Examination of medication subclasses showed that use of diuretics (adjusted hazard ratio, 0.57; 95% CI, 0.33-0.94), and specifically potassium-sparing diuretics (adjusted hazard ratio, 0.26; 95% CI, 0.08-0.64), was associated with the greatest reduction in risk of AD. Corresponding analysis with a fully examined subsample controlling for blood pressure measurements did not substantially change the findings. The authors concluded that these data suggest that AH medications, and specifically potassium-sparing diuretics, are associated with reduced incidence of AD. Because the latter association is a new finding, it requires confirmation in further study.

Khachaturian AS, Zandi PP, Lyketsos CG, et al, for the Cache County Study Group. Antihypertensive medication use and incident Alzheimer disease: The Cache County Study. Arch Neurol 2006;63: 686-692.

HIP PROTECTORS FOR PREVENTING FRACTURE
The authors’ objective was to present the updated results of a systematic review of current evidence for the effectiveness of hip protectors from reports of completed randomized trials, and to explore the evolution of that evidence. Sources used were Cochrane Bone, Joint, and Muscle Trauma Group trials register (January 2005), Cochrane central register of controlled trials (Cochrane Library Issue 1, 2005), MEDLINE (1966 to January 2005), EMBASE (1988 to January 2005), and CINAHL (1982 to December 2004). Other databases and reference lists of relevant articles were searched, and some trialists were contacted. They looked at randomized or quasirandomized controlled trials reporting the incidence of hip fractures, pelvic fractures, and other fractures in elderly people offered hip protectors, compared with a control group that was not. Outcomes for fracture were available from 14 randomized and quasirandomized trials. Pooling of data from 11 trials carried out in nursing or residential care settings, including six cluster randomized studies, showed evidence of a marginally statistically significant reduction in incidence of hip fracture (relative risk 0.77; 95% confidence interval, 0.62 to 0.97). Pooling of data from three individually randomized trials of 5135 community-dwelling participants showed no reduction in hip fracture incidence with provision of hip protectors (1.16, 0.85 to 1.59). No evidence was found of any significant effect of hip protectors on incidence of pelvic or other fractures. No important adverse effects of hip protectors were reported, but compliance—particularly in the long term—was poor. The authors concluded that on the basis of early reports of randomized trials, hip protectors were advocated. Accumulating evidence indicates that hip protectors are an ineffective intervention for those living at home, and that their effectiveness in an institutional setting is uncertain.

Parker MJ, Gillespie WJ, Gillespie LD. Effectiveness of hip protectors for preventing hip fractures in elderly people: Systematic review. BMJ 2006;332:571-573.