Antihypertensive overtreatment in people 80 years old and older

Abstract

Background and objective: To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment.

Patients and methods: Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications.

Results: The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication.

Conclusions: The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription.

Keywords: Ancianos; Deprescripción; Deprescription; Elderly; Hipertensión; Hypertension; Overtreatment; Sobretratamiento; Tratamiento y control; Treatment and control.