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Characterising older adults' risk of harm from blood-pressure lowering medications: a sub-analysis from the PRIME
Ahmed Hussain1, Khalid Ali1,2, Nikesh Parekh1,2
1Department of Elderly Medicine, University Hospitals Sussex NHS Foundation Trust, Sussex, UK.
Insights
Older adults on multiple blood pressure drugs face higher risks of medication-related harm. Careful consideration of cardiovascular risk reduction is needed to prevent harm in this population.
Area of Science:
- Gerontology
- Pharmacology
- Cardiology
Background:
- Cardiovascular disease (CVD) is prevalent in frail older adults.
- Evidence for CVD treatments often excludes older adults with multimorbidity.
- Blood pressure-lowering drugs can cause medication-related harm (MRH) in the elderly.
Purpose of the Study:
- Identify clinical and sociodemographic factors linked to MRH.
- Analyze MRH in older individuals prescribed BP-lowering medications.
- Assess the risk of MRH in elderly patients using BP-lowering drugs.
Main Methods:
- Utilized data from the PRIME study, a prospective investigation in Southern England.
- Included adults aged 65+ discharged from five teaching hospitals.
- Assessed MRH through telephone interviews, primary care record reviews, and hospital readmissions over 8 weeks.
Main Results:
- 12% of patients experienced 153 MRH events related to BP-lowering drugs.
- Patients on four BP-lowering drugs were 5x more likely to experience MRH (OR 4.96).
- 80% of MRH events were serious, and 49% were potentially preventable.
Conclusions:
- Polypharmacy with BP-lowering drugs is linked to preventable harm in older adults.
- Decisions on cardiovascular risk reduction require careful evaluation of MRH.
- Prioritizing patient safety is crucial when managing BP in the elderly.
Aim:
Cardiovascular disease (CVD) is common amongst frail older people. The evidence base for CVD commonly excludes older adults with multimorbidity or chronic conditions. Most cardiovascular drugs have the potential to lower blood pressure (BP) and therefore cause medication-related harm (MRH). We aimed to identify key clinical and sociodemographic characteristics associated with MRH in older people taking BP-lowering drugs for whatever indication they were prescribed.
Methods:
The PRIME (prospective study to develop a model to stratify the risk of MRH in hospitalised elderly patients in the UK) study investigating the incidence and cost of MRH in older people across Southern England. Adults ≥65 years were recruited from five teaching hospitals at hospital discharge and followed up for 8 weeks. Telephone interviews with study participants, review of primary care records and hospital readmissions were undertaken to identify MRH. PRIME study participants taking BP-lowering drugs (as defined by National Institute for Health and Care Excellence hypertension guidelines) were included in this analysis.
Results:
One hundred and four (12%) study patients experienced a total of 153 MRH events associated with BP-lowering drugs. Patients on four BP-lowering drugs were five times more likely to experience MRH compared to those taking one medication (OR 4.96; 95%CI 1.63-15.13; P = 0.01). Most MRH events were classified 'serious' (80%, n = 123), requiring dose change or treatment cessation. Almost half of MRH were potentially preventable (49%, n = 75).
Conclusion:
Polypharmacy from BP-lowering drugs in older people is associated with preventable harm. Decisions around cardiovascular risk reduction should be carefully considered in view of MRH arising from BP-lowering drugs.
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