Background Older hypertensive patients should attempt lifestyle modification to lower the blood pressure. If the blood pressure goal is not attained with lifestyle modification, antihypertensive treatment should be initiated.
Purpose To evaluate the effectiveness and safety of antihypertensive drugs in institutionalised older hypertensive patients.
Material and methods Retrospective descriptive study including all older patients treated with antihypertensive treatment who lived in a public elderly residence. Follow-up was three months (February–May 2014).
Parameters analysed were: systolic (SBP) and diastolic (DBP) blood pressure, kind of hypertension, cardiovascular risk factors (CVRF), vascular and/or organ injury and safety.
The collected data were obtained from Savac (prescription and validation program) and clinical records.
Results A total of 141 residents included 74 hypertensive patients (52.48%). The mean value of SBP was 122.6 mmHg (160–80) and DBP was 65.37 mmHg (89–49). Most patients had primary hypertension.
32.4% of patients had two CVRF, 44.6% had three, 20.3% had four and 2.7% had five. The most important CVRF (excluding age and inactivity) was dyslipidaemia. Cardiovascular risk was stratified in medium (13.5%), high (14.8%) and very high (71.7%). Clinical lesions were diagnosed in 73% of patients.
44.6% of patients were treated with only one antihypertensive but 21.6% and 6.7% were treated with four and five antihypertensive drugs. According to ESH/ESC Guidelines,1 the prescriptions were adjusted in left ventricular hypertrophy, renal failure and diabetes mellitus (88.89%, 76.92% and 63.64% respectively). The effectiveness was 84.85% with one antihypertensive, 70% with two, 68.8% with three and 40% with four.
The adverse effects were: 31 orthostatic hypotension, 8 dizziness and 8 hyperkalaemia.
The pharmaceutical interventions were conducted by two pharmacists and all accepted.
Conclusion The antihypertensive treatment in the elderly was effective and clinical trials have consistently demonstrated benefit.1,2 However, the orthostatic hypotension was higher than in other studies (41.8% vs. 20%).1,3
ESH/ESC Guidelines 2013
Urshila S, Mergenhagen KA, Kellick K. Effectiveness and safety of dual renin-angiotensin system blockade: a comparison between younger and older cohorts. Consult Pharm 2013;28(6):383–9
van Hateren KJ, Kleefstra N, Blanker MH, et al. Orthostatic hypotension, diabetes, and falling in older patients: a cross-sectional study. Br J Gen Pract 2012;62(603):e696–702
ReferencesNo conflict of interest.
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