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Revised guidelines for cardiovascular risk management - time to stop medication? A practice-based intervention study
Huug J van Duijn1, Janneke N Belo, Jeanet W Blom
1Health Cooperative Katwijk langs de Rijn, Katwijk, The Netherlands. hj@vduijn.nl
Insights
Many patients treated for hypertension and hypercholesterolemia may not need medication. A re-evaluation program identified over half as low-risk, with younger, female, non-smokers most likely to stop treatment successfully.
Area of Science:
- Cardiovascular risk management
- General practice research
- Pharmacotherapy optimization
Background:
- Dutch guideline suggests low-risk patients may not benefit from cardiovascular medication.
- Unnecessary medication treatment is prevalent in general practices.
- Target organ damage is a key factor in medication necessity.
Purpose of the Study:
- To assess the feasibility of re-evaluating patients on hypertension and/or hypercholesterolemia medication.
- To determine the consequences of medication discontinuation for low-risk patients.
- To identify factors influencing successful cessation of cardiovascular medication.
Main Methods:
- A practice-based intervention study involving six general practices.
- 833 patients treated for hypertension/hypercholesterolemia without target organ damage were included.
- Logistic regression analyzed indicators for successful medication cessation; practice differences were examined.
Main Results:
- Two-thirds of patients were re-evaluated; 61% had low cardiovascular risk.
- 42% were advised to stop medication, particularly younger, female, non-smokers.
- 9.6% of patients discontinued medication successfully for 6 months with no significant side effects.
Conclusions:
- Over 50% of patients without target organ damage may not require hypertension/hypercholesterolemia medication.
- Younger patients, females, and non-smokers are more likely candidates for medication cessation.
- Healthcare providers' (GPs, nurse practitioners) opinions influence medication stopping and restarting decisions.
Background:
According to the new Dutch guideline for cardiovascular risk management, patients with a low risk of cardiovascular mortality may have insufficient benefit to warrant medication. Therefore, numerous patients per general practice may be treated unnecessarily.
Aim:
To explore the feasibility and consequences of a re-evaluation programme for patients without target organ damage who were treated for hypertension and/or hypercholesterolaemia.
Design And Setting:
Practice-based intervention study in six general practices.
Method:
Patients treated for hypertension and/or hypercholesterolaemia without target organ damage (n = 833) were invited to re-evaluate their cardiovascular risk and were advised whether or not to stop medication. Patients who discontinued medication were followed for 6 months. To determine indicators for successful stopping, logistic regression analyses were performed, and differences between practices were analysed.
Results:
About two-thirds of the patients were re-evaluated and 61% of them had a low calculated risk, especially younger patients, females, and non-smokers. Of these, 42% were advised to stop medication, especially younger patients and non-smokers. Of those who discontinued medication, 40% had restarted within 6 months. After 6 months, 80 of the 833 patients (9.6%) had not restarted medication. There were no important side effects related to stopping medication.
Conclusion:
Over 50% of patients without target organ damage treated for hypertension and/or hypercholesterolaemia may have insufficient benefit to warrant medication. Younger patients, females, and non-smokers in particular are more likely to have an insufficient indication for medication. GPs' and nurse practitioners' views seem to play a role in advising to stop or to restart medication.
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