Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives

Wang, Philip S.; Avorn, Jerry; Brookhart, M. Alan; Mogun, Helen; Schneeweiß, Sebastian; Fischer, Michael; Glynn, Robert J.

doi:10.1161/01.hyp.0000172753.96583.e1

Cited by 82 publications

(77 citation statements)

References 56 publications

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“…If this finding is confirmed in larger studies, then "renalism" may be simply another manifestation of the known treatment bias against older patients. By contrast, unrelated comorbidity has been shown to be associated with reduced treatment rates in other diseases (21). Further research is needed to clarify this point.…”

Section: Discussionmentioning

confidence: 96%

Kidney Function and Use of Recommended Medications after Myocardial Infarction in Elderly Patients

Winkelmayer

Charytan

Brookhart

et al. 2006

Clinical Journal of the American Society of Nephrology

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Several studies have found reduced use of recommended medications after myocardial infarction (MI) in patients with impaired kidney function. However, the reasons for such undertreatment are not well understood. A total of 1380 Medicare patients who survived at least 90 d after MI and had prescription drug coverage through Pennsylvania's medication assistance program for the elderly were studied. Filled prescriptions were used to assess use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), ␤ blockers, and statins within 90 d of MI. Patients' demographics, comorbidities, and health care utilization before MI also were ascertained. We used logistic regression to test the association between kidney function and postdischarge use of each medication. Overall, 619 (45%) patients filled a prescription for a ␤ blocker, 675 (49%) received an ACEI or ARB, and 406 (29%) received a statin after discharge but within 90 d after their admission for MI. Reduced kidney function was associated with both lower ␤ blocker and statin use (P ‫؍‬ 0.01 and P ‫؍‬ 0.002, respectively), but after multivariate adjustment, these associations disappeared (P ‫؍‬ 0.23 and P ‫؍‬ 0.62, respectively). Use of ACEI or ARB was nearly half in patients with estimated GFR <30 ml/min compared with patients with better kidney function in univariate and multivariate analyses (P < 0.001). Analyses using serum creatinine measurements rather than estimations of GFR yielded similar results. Differences in other characteristics such as age, rather than kidney function, may be responsible for much or all the reported reduction in use of preventive medications after MI seen in patients with chronic kidney disease.

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Section: Discussionmentioning

confidence: 96%

Kidney Function and Use of Recommended Medications after Myocardial Infarction in Elderly Patients

Winkelmayer

Charytan

Brookhart

et al. 2006

Clinical Journal of the American Society of Nephrology

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“…41 In more than half of the population older than 65 years, multiple chronic diseases, related or unrelated to hypertension, are present. [42][43][44] Clinical practical guidelines for hypertension do not address older individuals with multiple comorbidities. 41 The presence of conditions unrelated to hypertension have been associated with decreased use of antihypertensive drugs in older patients, 44 although in those with hypertension-related chronic comorbidities, such as coronary heart disease and diabetes, the treatment patterns are the opposite.…”

Section: Discussionmentioning

confidence: 99%

“…41 The presence of conditions unrelated to hypertension have been associated with decreased use of antihypertensive drugs in older patients, 44 although in those with hypertension-related chronic comorbidities, such as coronary heart disease and diabetes, the treatment patterns are the opposite. 33,43 However, even though a greater proportion of older people were on multiple antihypertensive drugs, the control of hypertension was worse. 33,41 Thus, elderly patients may have limits that may prevent them reaching the target recommended by the recent guidelines even if the patient compliance and the expertise of physician are adequate.…”

Section: Discussionmentioning

confidence: 99%

Despite evidence-based guidelines, systolic blood pressure remains inadequately controlled in older hypertensive adults

Antikaínen

Kastarinen

Jousilahti³

et al. 2009

J Hum Hypertens

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We aimed to assess the trends in the prevalence, awareness, treatment and control of hypertension in Finnish men and women aged 60-74 years. Three independent cross-sectional population surveys were conducted in 1997, 2002 and 2007 remained stable. The mean diastolic blood pressure (BP) decreased in both genders. Awareness of hypertension increased from 60 to 71% in men (Po0.001 for trend) and from 66 to 76% (P ¼ 0.012) in women. The prevalence of antihypertensive drug treatment among hypertensive people increased from 35 to 56% in both genders (Po0.001). The proportion of treated hypertensive patients with adequately controlled BP increased from 16 to 32% in men (Po0.001) and from 16 to 30% in women (P ¼ 0.003). Hypertension care in older adults has improved in Finland during 1997 to 2007. The situation is not optimal: the main problem in this age group is high SBP.

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“…For example, patients with MCCs frequently face unwieldy medication regimens and daily self-care routines that may reduce adherence to recommended treatment plans. [4][5][6][7][8] They also often need to track and coordinate health information from different health care providers 9 and monitor and distinguish between symptoms from different diseases. [10][11][12] As a result, there is a great need for effective tools to support the self-care activities associated with multiple health issues.…”

Section: Introductionmentioning

confidence: 99%

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions

et al. 2015

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BACKGROUND: Patient eHealth technology offers potential support for disease self-management, but the value of existing applications for patients with multiple chronic conditions (MCCs) is unclear. OBJECTIVES: To understand self-management and health care navigation challenges that patients face due to MCCs and to identify opportunities to support these patients through new and enhanced eHealth technology. DESIGN: After administering a screening survey, we conducted 10 focus groups of 3-8 patients grouped by age, sex, and common chronic conditions. Patients discussed challenges associated with having MCCs and their use of (and desires from) technology to support self-management. Three investigators used standard content analysis methods to code the focus group transcripts. Emergent themes were reviewed with all collaborators, and final themes and representative quotes were validated with a sample of participants. PARTICIPANTS: Fifty-three individuals with≥3 chronic conditions and experience using technology for healthrelated purposes. KEY RESULTS: Focus group participants had an average of five chronic conditions. Participants reported using technology most frequently to search for health information (96 %), communicate with health care providers (92 %), track medical information (83 %), track medications (77 %), and support decision-making about treatment (55 %). Three themes emerged to guide eHealth technology development: (1) Patients with MCCs manage a high volume of information, visits, and self-care tasks; (2) they need to coordinate, synthesize, and reconcile health information from multiple providers and about different conditions; (3) their unique position at the hub of multiple health issues requires self-advocacy and expertise. Focus groups identified desirable eHealth resources and tools that reflect these themes. CONCLUSIONS:Although patients with multiple health issues use eHealth technology to support self-care for specific conditions, they also desire tools that transcend disease boundaries. By addressing the holistic needs of patients with MCCs, eHealth technology can advance health care from a disease-centered to a patientcentered model.

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Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives

Cited by 82 publications

References 56 publications

Kidney Function and Use of Recommended Medications after Myocardial Infarction in Elderly Patients

Kidney Function and Use of Recommended Medications after Myocardial Infarction in Elderly Patients

Despite evidence-based guidelines, systolic blood pressure remains inadequately controlled in older hypertensive adults

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions

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