Background During hospital admission, therapeutic interchange (TI) is performed on patients in treatment with angiotensin receptor blockers (ARBs) different from losartan, which are not included in the Pharmacotherapeutic Formulary. After TI, control of blood pressure(BP) should be stable.
Purpose To evaluate the effectiveness of the TI of ARBs during the hospital stay,comparing the number of hypertensive patients with controlled BP before and after TI.
Material and methods Observational prospective cohort study carried out from April to May 2016. Patients with hypertension treated with an ARBs not included in the Pharmacotherapeutic Formulary were enrolled, following them until discharge. Patients with a ARBs-conditional treatment according to blood pressure, people under 18 years’ old, pregnant females and patients with an hospital stay of 2 or less days were excluded. Patients were recommended a TI, being classified as exposed those in which the prescribing physician accepted the TI and as unexposed those in which the TI was rejected. The variables collected were:sex, age, main diagnosis, hospital stay, daily value of BP during hospital setting and BP before admission.
Results A total of 54 patients were enrolled, including 39 exposed and 15 unexposed. The 65% were female, 26 (67%) in the exposed group and nine (60%) in the unexposed group. The mean age was 74.6 years’ old, 76.5 years and 69.5 years respectively. In 53%, the main diagnosis was cardiac or respiratory pathology. The mean stay was 5.9 days for the exposed group, in contrast to 8.5 days for the unexposed group. Sixty-nine per centof the exposed group had a stable BP during admission versus 53% of the unexposed group. Five patients from the exposed group who did not control BP at home were able to control it during admission. However, four patients who had adequate BP control at home did not achieve it during admission, either because of the main diagnosis or because TI was not effective. Regarding the unexposed patients, there were two patients with controlled BP at home that did not have BP control during hospital stay.
Conclusion Therapeutic interchange has proved to be effective as it does not lead to a worsening of BP control over previous treatment. The majority of patients with TI controlled BP during hospital admission. Limitation: the average stay is lower in the cases, but it is not known if some external factors could have influenced this.
No conflict of interest
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