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Antihypertensives and Cardiovascular Medications

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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.

Keywords

  • Antihypertensive Medication
  • Thiazide Diuretic
  • Blood Pressure Goal
  • Medication Reconciliation
  • Cardiovascular Medication

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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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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Correspondence to Rebecca L. Salbu PharmD, CGP .

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Salbu, R.L., Leipzig, R.M., Ko, F.C. (2016). Antihypertensives and Cardiovascular Medications. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_12

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  • DOI: https://doi.org/10.1007/978-3-319-32304-6_12

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