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Multiple antihypertensive use and risk of mortality in residents of aged care services: a prospective cohort study

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Abstract

Aims

The objective of this study is to investigate the association between multiple antihypertensive use and mortality in residents with diagnosed hypertension, and whether dementia and frailty modify this association.

Methods

This is a two-year prospective cohort study of 239 residents with diagnosed hypertension receiving antihypertensive therapy across six residential aged care services in South Australia. Data were obtained from electronic medical records, medication charts and validated assessments. The primary outcome was all-cause mortality and the secondary outcome was cardiovascular-related hospitalizations. Inverse probability weighted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Covariates included age, sex, dementia severity, frailty status, Charlson’s comorbidity index and cardiovascular comorbidities.

Results

The study sample (mean age of 88.1 ± 6.3 years; 79% female) included 70 (29.3%) residents using one antihypertensive and 169 (70.7%) residents using multiple antihypertensives. The crude incidence rates for death were higher in residents using multiple antihypertensives compared with residents using monotherapy (251 and 173/1000 person-years, respectively). After weighting, residents who used multiple antihypertensives had a greater risk of mortality compared with monotherapy (HR 1.40, 95%CI 1.03–1.92). After stratifying by dementia diagnosis and frailty status, the risk only remained significant in residents with diagnosed dementia (HR 1.91, 95%CI 1.20–3.04) and who were most frail (HR 2.52, 95%CI 1.13–5.64). Rate of cardiovascular-related hospitalizations did not differ among residents using multiple compared to monotherapy (rate ratio 0.73, 95%CI 0.32–1.67).

Conclusions

Multiple antihypertensive use is associated with an increased risk of mortality in residents with diagnosed hypertension, particularly in residents with dementia and among those who are most frail.

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Acknowledgements

The authors thank Resthaven staff and residents for their participation in this study.

Funding

The data used for this study were collected with support from the Alzheimer Australia Dementia Research Foundation via the Resthaven Incorporated Dementia Research Award. ECKT was supported by an Australian National Health and Medical Research Council-Australian Research Council (NHMRC-ARC) Dementia Research Development Fellowship (APP1107381). JSB was supported by an NHMRC Dementia Leadership Fellowship. JI was supported by an NHMRC Early Career Fellowship. NJ was supported by an Australian Government Research Training Program Scholarship.

Author information

Authors and Affiliations

  1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia

    Miriam Kerry, J. Simon Bell, Claire Keen, Janet K. Sluggett, Jenni Ilomäki, Natali Jokanovic & Edwin C. K. Tan

  2. School of Pharmacy, University of Nottingham, Nottingham, UK

    Miriam Kerry

  3. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia

    J. Simon Bell & Janet K. Sluggett

  4. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia

    J. Simon Bell

  5. National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, Australia

    J. Simon Bell

  6. Resthaven Incorporated, Adelaide, Australia

    Tina Cooper & Leonie Robson

  7. The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia

    Edwin C. K. Tan

  8. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Edwin C. K. Tan

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  1. Miriam Kerry
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Corresponding author

Correspondence to Edwin C. K. Tan.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in this study were in accordance with the ethical standards of the Royal Australian College of General Practitioners National Research and Evaluation Ethics Committee and the Monash University Health Research Ethics Committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Where residents were unable to provide informed consent, consent was obtained from a guardian, next of kin, or significant other.

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Kerry, M., Bell, J.S., Keen, C. et al. Multiple antihypertensive use and risk of mortality in residents of aged care services: a prospective cohort study. Aging Clin Exp Res 32, 1541–1549 (2020). https://doi.org/10.1007/s40520-019-01336-x

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  • DOI: https://doi.org/10.1007/s40520-019-01336-x

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