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Prescribing cascade: calcium-channel blockers and diuretics

    Drug and Therapeutics Bulletin
    |November 17, 2020
    PubMed

    Insights

    This study examined a common prescribing cascade involving calcium-channel blockers and diuretics in older adults with hypertension. The findings highlight potential medication-related harm and the need for improved prescribing practices in geriatric hypertension management.

    Area of Science:

    • Geriatric Medicine
    • Cardiovascular Pharmacology
    • Clinical Pharmacy

    Background:

    • Hypertension is a prevalent condition in older adults.
    • Prescribing cascades, where a drug is initiated to treat a side effect of another drug, are a concern in geriatric polypharmacy.
    • Calcium-channel blockers and diuretics are commonly prescribed for hypertension.

    Purpose of the Study:

    • To evaluate the frequency and impact of a specific prescribing cascade involving calcium-channel blockers and diuretics in older adults with hypertension.
    • To identify the clinical outcomes associated with this prescribing cascade.

    Main Methods:

    • Retrospective cohort study using administrative health data.
    • Inclusion of older adults (age 65+) diagnosed with hypertension.
    • Analysis of medication prescribing patterns and healthcare utilization.

    Main Results:

    • A significant proportion of older adults with hypertension were exposed to the calcium-channel blocker and diuretic prescribing cascade.
    • This cascade was associated with increased healthcare utilization and adverse events.
    • Specific patterns of drug initiation and discontinuation were identified.

    Conclusions:

    • The evaluated prescribing cascade is common in older adults with hypertension and may lead to suboptimal care.
    • Interventions aimed at optimizing antihypertensive prescribing in the elderly are warranted.
    • Further research should focus on preventing and mitigating prescribing cascades in this population.

    Keywords:
    accessdrug interactionsevaluationhealth care quality

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