Association Between Antihypertensive Medication Use and Non-cardiovascular Outcomes in Older Men

Agostini, Joseph V.; Tinetti, Mary E.; Han, Ling; Peduzzi, Peter; Foody, JoAnne M.; Concato, John

doi:10.1007/s11606-007-0388-9

Cited by 9 publications

(15 citation statements)

References 44 publications

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“…23 Intensity of antihypertensive medication use was defined by: 1) number of antihypertensive classes prescribed across all four of the 3-month intervals (assigned scores ranging from zero to 20), and 2) number of antihypertensive classes subjects were exposed to for at least two of the 3-month intervals. Timed chair stands were used to measure functional status.…”

Section: Resultsmentioning

confidence: 99%

“…Researchers reported no association in two studies 22,77 and increased risk of functional status decline in six studies. 20, 21,23, 27,63,72 Of the remaining 10 studies, eight assessed self-reported BADL and/or IADL, 58–59,62,64, 70,73,75,94 one examined self-reported mobility only, 15 and two evaluated self-reported SF-36 Physical Functioning or AKPS scores as functional status measures. 71,74 …”

Section: Discussionmentioning

confidence: 99%

“…21–22 The SPPB evaluates balance, gait, strength, and endurance by testing one’s ability to stand with feet together in three positions (i.e., side-by-side, semi-tandem, and tandem), time required to walk eight feet, and time required to rise from a chair and return to the seated position five times. 17 Timed chair stands have been used alone to measure functional status 23 though the clinical significance of this measure by itself is unclear. 24 Lastly, the Functional Independence Measure (FIM) is a widely-accepted functional assessment measure in the rehabilitation community.…”

Section: Introductionmentioning

confidence: 99%

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Medication Use and Functional Status Decline in Older Adults: A Narrative Review

Peron

Gray

Hanlon

2011

The American Journal of Geriatric Pharmacotherapy

110

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OBJECTIVE To critically review published articles that have examined the relationship between medication use and functional status decline in the elderly. METHODS The MEDLINE and EMBASE databases were searched for English-language articles published from January 1986 to December 2010. Search terms included aged, humans, drug utilization, polypharmacy, inappropriate prescribing, anticholinergics, psychotropics, antihypertensives, drug burden index, functional status, function change or decline, activities of daily living, gait, mobility limitation, and disability. A manual search of the reference lists of the identified articles and the authors’ article files, book chapters, and recent reviews was conducted to retrieve additional publications. Only articles that used rigorous observational or interventional designs were included. Cross-sectional studies and case series were excluded from this review. RESULTS Nineteenstudies met the inclusion criteria. Five studies addressed the impact of suboptimal prescribing on function, three of which found an increased risk of worse function in community-dwelling subjects receiving polypharmacy. Three of the four studies that assessed benzodiazepine use and functional status decline found a statistically significant association. One cohort study identified no relationship between antidepressant use and functional status while a randomized trial found that amitriptyline, but not desipramine or paroxetine, impaired certain measures of gait. Two studies found that increasing anticholinergic burden was associated with worse functional status. In a study of hospitalized rehabilitation patients, users of hypnotics/anxiolytics (e.g., phenobarbital, zolpidem) had lower relative Functional Independence Measure motor gains than nonusers. Use of multiple central nervous system (CNS) drugs (using different definitions) was linked to greater declines in self-reported mobility and Short Physical Performance Battery (SPPB) scores in two community-based studies. Another study of nursing home patients did not report a significant decline in SPPB scores in those taking multiple CNS drugs. Finally, two studies found mixed effects between antihypertensive use and functional status in the elderly. CONCLUSION Benzodiazepines and anticholinergics have been consistently associated with impairments in functional status in the elderly. The relationships between suboptimal prescribing, antidepressants, and antihypertensives and functional status decline were mixed. Further research using established measures and methods is needed to better describe the impact of medication use on functional status in older adults.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medication Use and Functional Status Decline in Older Adults: A Narrative Review

Peron

Gray

Hanlon

2011

The American Journal of Geriatric Pharmacotherapy

110

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“…Data on demographic profiles, health-behaviors, comorbidities, blood pressure readings, cognitive and physical functioning were collected at baseline and at one year follow-up. The study protocol was approved by the Yale University School of Medicine institutional review board and the VA Connecticut Healthcare System Human Subjects Subcommittee and has been described previously (17, 18). In 2005, additional data were collected on medications from a subset of 544 male cohort members with diagnosed hypertension.…”

Section: Methodsmentioning

confidence: 99%

Antidepressant Use and Cognitive Deficits in Older Men: Addressing Confounding by Indications with Different Methods

Han

Kim

Brandt

et al. 2012

Annals of Epidemiology

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Purpose Antidepressant use has been associated with cognitive impairment in older persons. This study sought to examine whether this association might reflect an indication bias. Methods 544 community-dwelling hypertensive men aged ≥65 years completed the Hopkins Verbal Learning Test (HVLT) at baseline and one year. Antidepressant medications were ascertained using medical records. Potential confounding by indications was examined by adjusting for depression-related diagnoses and severity of depression symptoms using multiple linear regression (MLR), a propensity-score (PS) and a structural equation model (SEM). Results Before adjusting for the indications, a one unit cumulative exposure to antidepressants was associated with −1.00 (95% Confidence Interval (CI): −1.94, −0.06) point lower HVLT score. After adjusting for the indications using MLR or a PS, the association diminished to −0.48 (95% CI: −0.62, 1.58) and −0.58 (95% CI: −0.60, 1.58), respectively. The most clinical interpretable empirical SEM with adequate fit involves both direct and indirect paths of the two indications. Depression-related diagnoses and depression symptoms significantly predict antidepressant use (P <0.05). Their total standardized path coefficients on HVLT score were twice (0.073) or as large (0.034) as the antidepressant use (0.035). Conclusion The apparent association between antidepressant use and memory deficit in older persons may be confounded by indications. SEM offers a heuristic empirical method for examining confounding by indications, but not quantitatively superior bias reduction compared to conventional methods.

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“…The risk estimates for CVD and serious fall injuries were based on the best available clinical trial and epidemiological evidence. [2][3][4][5][6][7][8][22][23][24][25] It was estimated that the 5-year risk of CVD outcomes would be 26% without treatment for the average older individual and would decrease to 18% (absolute risk reduction) with antihypertensive medications. The two risk estimates for CVD were, therefore, 26% (presented as 26 of 100 persons) and 18% (presented as 18 of 100 persons).…”

Section: Development Of the Choice Taskmentioning

confidence: 99%

Development of a Tool for Eliciting Patient Priority from Among Competing Cardiovascular Disease, Medication‐Symptoms, and Fall Injury Outcomes

Tinetti

McAvay

Fried

et al. 2008

J American Geriatrics Society

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OBJECTIVES-To develop a choice task for eliciting priorities in the face of competing cardiovascular disease (CVD) outcomes, medication-related symptoms, and fall injuries. DESIGN-Conjoint analysis. SETTING-Senior housing site.PARTICIPANTS-Convenience sample of 15 senior housing residents for the pretest, 13 residents for the pilot test. MEASUREMENTS-The final task included 11 sets of choices. In each, one option optimized the risk of one or two of the three outcomes at the expense of the other(s); the second option did the reverse. Relative importance scores for CVD, fall injury, and medication-symptom outcomes were calculated. Reliability was assessed for two administrations using intraclass correlations (ICCs). Wilcoxon rank sum tests were used to evaluate order effects. RESULTS-The Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that none of the authors have any financial or any other kind of personal conflicts with this manuscript. This study was supported by Grant R21 AG027078 and Grant P30AG21342 from the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine, both from the National Institute on Aging. Dr. Foody was supported by National Institutes of Health, NIA Career Development Award K08-AG20623-01 and an NIA/Hartford Foundation Fellowship in Geriatrics. Dr. Fraenkel was supported by K23 AR048826 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Fried was supported by K02 AG20113 from the NIA. 0.84, 0.72, and 0.84, respectively. Whether CVD or fall injuries appeared first had no effect on scores. NIH Public AccessCONCLUSION-Preliminary evidence of comprehensibility and reliability supports using the choice task to determine whether individuals' priorities differ in the face of competing outcomes.Keywords patient priorities; competing health outcomes; clinical decision-makingIn patients with multiple health conditions, the treatment of one condition may worsen another one. Clinical decision-making should incorporate patients' priorities when faced with these potentially competing health outcomes. 1 The older adult with coexisting hypertension and fall risk represents a common clinical situation for which a method for eliciting patient priorities would be useful.Falls and hypertension are both major causes of disability. The 3-year incidence of all nonfatal cardiovascular events in older adults with hypertension is 16.2%, 2 similar to the incidence of serious fall injury in elderly persons with fall risk. The co-occurrence of hypertension and fall risk, therefore, can serve as a model for studying health priorities in the face of potentially competing health conditions, although eliciting priorities raises concerns about well-known challenges, including reluctance to articulate feelings about outcomes not yet experienced, the tendency to select all outcomes as equally important, and change in priorities with time and changing health status. 12,13 Limited...

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Association Between Antihypertensive Medication Use and Non-cardiovascular Outcomes in Older Men

Cited by 9 publications

References 44 publications

Medication Use and Functional Status Decline in Older Adults: A Narrative Review

Medication Use and Functional Status Decline in Older Adults: A Narrative Review

Antidepressant Use and Cognitive Deficits in Older Men: Addressing Confounding by Indications with Different Methods

Development of a Tool for Eliciting Patient Priority from Among Competing Cardiovascular Disease, Medication‐Symptoms, and Fall Injury Outcomes

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