Antihypertensives and Cardiovascular Medications

  • Rebecca L. Salbu
  • Rosanne M. Leipzig
  • Fred C. Ko
Chapter

Abstract

The use of antihypertensive drugs in the elderly population places patients at an increased risk of adverse drug events in both the inpatient and outpatient setting. The setting of appropriate blood pressure goals and using antihypertensive medications is complex and no consensus exists. Hypertension treatment goals need to be individualized. Well-known trials have described the risks of falls and fall-related injuries in older adults taking antihypertensive medications. The results from these studies may not be directly applicable to the population of frail older patients. In three meta-analyses conducted in 1999, 2009, and 2013, there was no clear statistically significant evidence indicating that antihypertensive medications increase the risk of falls, but the clinician still needs to be aware of the impact of drug therapies and fall-related injuries. Although the adverse relationship between cardiovascular medications and falls and fall-related injuries in older adults is supported by high-quality and well-conducted observational studies, only thiazide diuretics have been singled out. The safe and effective use of cardiovascular medications in physically frail older patients requires deliberate and thoughtful considerations. Managing polypharmacy, performing medication reconciliation and review, and employing deprescribing strategies will result in an appropriate cardiovascular medication regimen while minimizing adverse effects and reducing the risk for falls in older patients.

Abbreviations

ACCF

American College of Cardiology Foundation

ACCORD

Action to Control Cardiovascular Risk in Diabetes

ACE

Angiotensin-converting enzyme

ADA

The American Diabetes Association

AGS

American Geriatrics Society

ALLHAT

Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

ARB

Angiotensin II receptor blockers

ASH/ISH

The American Society of Hypertension and The International Society of Hypertension

BBs

Beta-blockers

CCBs

Calcium channel blockers

CHEP

The Canadian Hypertension Education Program

CI

Confidence interval

ESH/ESC

The European Society of Hypertension and The European Society of Cardiology

HR

Hazard ratio

HYVET

Hypertension in the Very Elderly Trial

JNC

Joint National Committee

KDIGO

The Kidney Disease Improving Global Outcomes workgroup

OR

Odds ratio

SBP

Systolic blood pressure

SHEP

Systolic Hypertension in the Elderly Program

SPRINT

Systolic Blood Pressure Intervention Trial

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Rebecca L. Salbu
    • 1
    • 2
  • Rosanne M. Leipzig
    • 3
  • Fred C. Ko
    • 3
    • 4
  1. 1.Department of Pharmacy PracticeTouro College of PharmacyNew YorkUSA
  2. 2.Mount Sinai HospitalNew YorkUSA
  3. 3.Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  4. 4.Geriatric Research, Education, and Clinical Center (GRECC)James J. Peters VA Medical CenterBronxUSA

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