Aubert, Carole E.; Ha, Jin-Kyung; Kerr, Eve A; Hofer, Timothy P; Min, Lillian (2021). Factors associated with antihypertensive treatment intensification and deintensification in older outpatients. International Journal of Cardiology. Hypertension, 9, p. 100098. Elsevier 10.1016/j.ijchy.2021.100098
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Background
New hypertension performance measures encourage more intensive treatment in older adults. Treatment intensification includes starting new medications and increasing the dose of old ones. Medication dose is particularly important to older adults, given their vulnerability to dose-related side effects. We previously validated a standardized measure of beneficial doses tested in hypertension trials, Hypertension Daily Dose (HDD).
Aim of the study
To test whether changes in treatment intensity using HDD was associated with systolic blood pressure (SBP) and patient characteristics.
Methods
Longitudinal study of all Veterans aged ≥65 years with a diagnosis of hypertension. We defined 3 groups of risk: 1) cardiovascular risk; 2) geriatric/frail; 3) low-risk (comparator). Using multinomial regression, we assessed the probability of deintensification, intensification, vs. stable treatment, according to SBP and group.
Results
Among 1,331,111 Veterans, 19.9% had deintensification, and 29.6% intensification. Deintensification decreased, while intensification increased, with SBP. Compared to low-risk patients, cardiovascular risk patients had 1.11 (95% CI 1.10-1.13) times the odds of intensifying, and geriatric/frail patients 1.45 (95%CI 1.43-1.47) times the odds of deintensifying.
Discussion
Patient-level HDD change was consistent with an expected association with cardiovascular risk and geriatric/frail conditions, suggesting that HDD can be used longitudinally to assess hypertension treatment modification in large health systems.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine 04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM) |
UniBE Contributor: |
Aubert, Carole Elodie |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
2590-0862 |
Publisher: |
Elsevier |
Funders: |
[4] Swiss National Science Foundation |
Language: |
English |
Submitter: |
Andrea Flükiger-Flückiger |
Date Deposited: |
28 Jul 2021 15:56 |
Last Modified: |
05 Dec 2022 15:52 |
Publisher DOI: |
10.1016/j.ijchy.2021.100098 |
PubMed ID: |
34258575 |
Uncontrolled Keywords: |
Deintensification Elderly Hypertension Intensification Medication Patterns Treatment Veterans |
BORIS DOI: |
10.48350/157662 |
URI: |
https://boris.unibe.ch/id/eprint/157662 |
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