Verordnung von Antihypertensiva bei geriatrischen Pflegeheimbewohnern in Deutschland

Abstract

Antihypertensive drugs account for a notable part (17 %) of all drug prescriptions in elderly residents of nursing homes throughout Germany. These results indicate that only a minority of all residents were treated with potentially inappropriate or potentially harmful drug combinations. However, the relatively high rate of prescriptions for loop diuretics is a matter of potential concern in this vulnerable group of patients.

Managing hypertension among nursing-home residents and community-dwelling elderly in Germany: a comparative pharmacoepidemiological study

“…Rates of private patients known to receive more expensive drugs were negligible in both groups in our study [34]. The high intake of loop diuretics in hypertensive elderly without a diagnosis of renal or heart failure has already been reported in former studies [7,12,15]. Remembering that inappropriate intake of loop diuretics can lead to exsiccosis and electrolyte loss, especially in the elderly, better medical education must follow these alarming results to improve the pattern of diuretic prescription.…”

“…Little is known about the quality of hypertension management, especially of institutionalized elderly in Germany. In 2010, Koelzsch et al analyzed the prescriptions of nursing-home (NH) residents with high BP by using data from a health insurance company [15]. To follow-up on these results, our research project was conducted to directly compare treatment of hypertension and comorbidities in long-term-care facilities with treatment in community-dwelling (CD) individuals.…”

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems

“…Additionally, 5.6% of patients on diuretics received concomitantly loop diuretics and thiazide/thiazide-like diuretics. Overprescription of loop diuretics without appropriate indication has been reported in 27.5% of nursing home residents ( Kölzsch et al, 2010 ). The concomitant use of spironolactone and ramipril as illustrated in our patient case increases the risk of hyperkalemia; a potentially severe DDI to which the elderly are more sensitive due to potassium homeostasis abnormalities, disorders e.g., diabetes mellitus or use of drugs e.g., RAS blockers and potassium-sparing diuretics ( Hunter and Bailey, 2019 ).…”

Arterielle Hypertonie, antihypertensive Therapie und Visit-to-visit-Blutdruckvariabilität bei älteren Pflegeheimbewohnern

“…Pflegeheimbewohner werden häufig mit Antihyper-tensiva behandelt, jedoch liegen zurzeit nur wenige Daten zur Behandlung der arteriellen Hypertonie bei dieser Population in Deutschland vor. Eine Untersuchung von Krankenkassendaten [6] zeigte, dass 70 % der Pflegeheimbewohner mindestens ein antihypertensives Medikament erhielten. In einer anderen Studie wurde berichtet, dass Pflegeheimbewohner signifikant weniger Antihypertensiva erhalten und der Blutdruck trotzdem besser eingestellt war als bei älteren Personen, die zu Hause lebten [9].…”

“…Die Verordnungshäufigkeit von Antihypertensiva in dieser Population war vergleichbar mit anderen Studien aus Deutschland [6,9]. In einer aktuellen Übersichtsarbeit wurde die Therapie der arteriellen Hypertonie von Pflegeheimbewohnern in Deutschland, Italien, Frankreich, Kanada, den U.S.A. und Malaysia untersucht [24].…”