Antihypertensives Overused Among Older Patients with Low Blood Pressure

Ryan Marotta, Assistant Editor
Published Online: Tuesday, July 12th, 2016
Clinicians should remain mindful of any potentially inappropriate antihypertensive medications taken by their elderly patients.
A recent study published in Age and Ageing analyzed data on 11,167 patients 70 years and older who were admitted to the University of Kent and East Kent Hospitals. Of 1899 patients with low blood pressure, 1246 (65.6%) were found to be on antihypertensive medication. This rate was higher (70%) among patients with a blood pressure <100 mmHg.
These results demonstrate that many older patients continue to take antihypertensives after their blood pressure drops to lower levels. Based on their analysis, the study authors concluded that the high proportion of hypotensive elderly patients taking antihypertensives could have a significant effect on hospital admissions, costs, quality of life, and mortality rates in this population. They noted that no link was found between the quantity of antihypertensives taken and mortality.
The study authors could not determine whether the hypotension was the cause of hospitalization or an effect of a different condition. They acknowledged that further research is needed to establish which patients are more likely to benefit from antihypertensive therapy.
However, they suggested that the overuse of antihypertensives in these patients could be due to a lack of regular evaluation by health care providers after the drugs are initially prescribed.
“Treating hypertension in old age reduces strokes and other cardiovascular events. However in elderly patients with multiple risks, there is a trade-off between using antihypertensives to reduce the risk of future disease and increased risk due to adverse effects of medication,” said lead author Chris Farmer, MD, in a press release. “Once medication is initiated, it is not always regularly reviewed to adjust for physiological changes associated with aging and the effects of additional drugs.”
Medication reconciliation efforts are an integral part of the care transition process. After patients have been discharged from the hospital, it is vitally important for care providers in all settings to keep an eye on medication regimens.
As retail clinicians are often ideally situated to help patients control their blood pressure and to prevent hospital admissions related to hypertension, many nurse practitioners and physician assistants may find themselves treating elderly patients who are currently using antihypertensives. Dr. Farmer and his peers ultimately encouraged all providers to carefully review patients’ use of these medications to ensure that the drugs’ benefits are outweighing their risks.

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