Impact of Hospitalization on Antihypertensive Pharmacotherapy among Older Persons

Abstract

BackgroundLittle is known about the impact of hospitalization on antihypertensive pharmacotherapy and blood pressure control in older persons.ObjectivesThe aim of this study was to explore the impact of hospitalization on the management of hypertension and antihypertensive pharmacotherapy in a cohort of older patients with a documented diagnosis of hypertension.MethodsA retrospective, cross-sectional medical record audit was conducted in a large Australian metropolitan teaching hospital. Patients aged 65 years or older, admitted between January 1st 2010 and December 31st 2010, and with a documented diagnosis of hypertension in their medical record were included in the study. Antihypertensive pharmacotherapy and blood pressure control was compared between admission and discharge. Factors associated with changes to antihypertensive pharmacotherapy were identified.ResultsChanges to antihypertensive pharmacotherapy occurred in 39.5 % (n = 135) of patients (n = 342). On discharge, the proportion of patients receiving antihypertensive pharmacotherapy (89.0 vs 85.3 %, p < 0.0001) and the mean number of antihypertensive agents per patient (1.7 ± 1.1 vs 1.5 ± 1.1, p < 0.0001) declined compared with admission. Adverse drug reactions [odds ratio (OR) = 5, 95 % confidence interval (CI): 2.80–9.34] were the main reason documented for antihypertensive pharmacotherapy changes. Patients admitted under the care of medical (OR = 0.3, 95 % CI: 0.17–0.70) or surgical (OR = 0.3, 95 % CI: 0.12–0.53) specialties were less likely to experience changes to their antihypertensive pharmacotherapy than those treated by gerontology or cardiology teams.ConclusionsHospitalization has a significant impact on antihypertensive pharmacotherapy. Two out of every five older persons on antihypertensive medications will experience changes to their regimens during admission to hospital with most changes in antihypertensive pharmacotherapy due to adverse drug reactions.

Prevalence, management and control of hypertension in older adults on admission to hospital

“…However the importance of understanding blood pressure control in older persons presenting to hospital should not be underestimated. Previous work in the same cohort found that 70% of the cohort was not at target BP prior to hospitalization (Alhawassi et al, 2015). The same research reported that hospitalization was associated with considerable change to antihypertensive medication regimens, even when the primary reason for admission is non-cardiovascular (Alhawassi et al, 2015).…”

“…Previous work in the same cohort found that 70% of the cohort was not at target BP prior to hospitalization (Alhawassi et al, 2015). The same research reported that hospitalization was associated with considerable change to antihypertensive medication regimens, even when the primary reason for admission is non-cardiovascular (Alhawassi et al, 2015). Finally, data extraction was undertaken by a single researcher to ensure consistency throughout the study but, common to all retrospective studies reliant on health record data, data quality and availability was dependent on the quality of documentation by the health care team at the time of care.…”

Antihypertensive treatment changes and related clinical outcomes in older hospitalized patients

“…It is well established that a comprehensive evaluation performed during hospitalization and the resulting drug treatment revision and reconciliation have a great impact on clinical outcomes in older patients. Indeed, previous reports identified hospitalization as a major factor that induced antihypertensive treatment modifications or discontinuation mainly due to adverse reactions 22,23 . Therefore, the correct management of any pharmacological therapy should be a balance between the correct prescription and the avoidance of adverse effects, and this seems to be particularly important in older subjects during in‐hospital stay and pharmacological reconciliation process.…”