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Differences in Health-Related Quality of Life Among Adults with a Potential Dihydropyridine Calcium Channel Blocker–Loop Diuretic Prescribing Cascade

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Abstract

Background

Dihydropyridine calcium channel blockers (DH CCBs) are commonly used for hypertension in older adults. However, loop diuretics can be inappropriately added to treat DH CCB-induced edema, putting individuals at increased risk for adverse events and potential decreases in quality of life.

Methods

We conducted a cross-sectional analysis using United States Medical Expenditure Panel Survey (MEPS) data from 2003 to 2015. Adults aged ≥ 55 years without congestive heart failure, nephrotic syndrome, chronic kidney disease, renal failure, and cirrhosis who had consecutive rounds of DH CCB use (round 1 and 2 or round 3 and 4) and completed the self-administered questionnaire (SAQ) were included. Patients initiated on loop diuretics in round 2 or 4 were compared to those not initiated. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed using multivariable linear regression models.

Results

Among 5,458,467 DH CCB users (weighted), 3.4% of individuals were identified with new loop diuretic use (185,130 weighted). After adjusting for covariates, DH CCB plus loop diuretic use was associated with a PCS score 3.12 units lower (95% confidence interval − 5.40 to − 0.83; p = 0.008) than DH CCB use alone. We observed no significant difference in MCS score (p = 0.160) among DH CCB plus loop diuretic users compared to DH CCB users alone.

Conclusions

New loop diuretic use was associated with lower physical functioning among DH CCB users. These findings suggest that this potential prescribing cascade may result in both significant and clinically meaningful decreases in health-related quality of life. It is important for clinicians to avoid or intervene on this inappropriate prescribing cascade when possible.

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Authors and Affiliations

  1. Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA

    Earl J. Morris, Joshua D. Brown & Scott M. Vouri

  2. Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA

    Joshua D. Brown, Todd M. Manini & Scott M. Vouri

  3. Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, USA

    Todd M. Manini & Scott M. Vouri

Authors
  1. Earl J. Morris
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  2. Joshua D. Brown
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  3. Todd M. Manini
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  4. Scott M. Vouri
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Corresponding author

Correspondence to Scott M. Vouri.

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Funding

This project was supported by a Claude D. Pepper Older American Independence Centers Junior Scholar Award from the University of Florida Institute on Aging through support from the National Institute on Aging at the National Institutes of Health (P30AG028740).

Conflict of interest

The authors have declared no conflicts of interest for this article.

Availability of data and material

The datasets generated during and/or analyzed during the current study are available in the Agency for Healthcare Research and Quality repository, https://meps.ahrq.gov/data_stats/download_data_files.jsp.

Code availability

Code available upon request.

Authors’ contributions

Conceived and designed the study: EM and SV. Conducted data analysis: EM and SV. Interpretation of data: EM, JB, TM, and SV. Preparation of manuscript: EM. All authors provided feedback to the study and critically revised the study materials.

Supplementary Information

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Supplementary file 1 (DOCX 101 kb)

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Morris, E.J., Brown, J.D., Manini, T.M. et al. Differences in Health-Related Quality of Life Among Adults with a Potential Dihydropyridine Calcium Channel Blocker–Loop Diuretic Prescribing Cascade. Drugs Aging 38, 625–632 (2021). https://doi.org/10.1007/s40266-021-00868-0

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  • DOI: https://doi.org/10.1007/s40266-021-00868-0

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