Desprescribing antihypertensives in older people in primary care: subgroup analysis of the MINOR randomised clinical trial.

IF 2.6 4区医学 Q2 PHARMACOLOGY & PHARMACY

International Journal of Clinical Pharmacy Pub Date : 2024-11-06 DOI:10.1007/s11096-024-01805-y

Igor Matheus Silva, Pablo Maciel Moreira, Alessa Maria Santos, Priscila Ribeiro Castro, Erlan Canguçu Aguiar, Marcio Galvão Oliveira

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引用次数: 0

Abstract

Background: Polypharmacy is often required for older adults with hypertension, and excessive treatment is associated with a high risk of adverse reactions, including hypotension.

Aim: To evaluate the deprescribing of antihypertensive medications guided by pharmacists using home blood pressure monitoring in older adults with hypotension.

Method: A subgroup of older adults with signs or symptoms of hypotension, included in the MINOR clinical trial, was analysed. In the MINOR procedures, each patient was provided with a device to conduct blood pressure measurement at home for 1 week, following which a report was generated and shared with pharmacists (intervention group) or family physicians (control group). In the intervention group, a pharmacist suggested optimising pharmacotherapy; meanwhile, in the control group, a family physician alone determined the necessary treatment adjustments. Differences in mean blood pressure, the patients with symptoms/signs of hypotension, and the antihypertensive medication deprescribing between both groups were analysed.

Results: Seventy-two patients were evaluated (35, control group; 37, intervention group). The intervention group showed a significant reduction in medication prescriptions (- 28.6%; P < 0.001), especially beta-blockers (- 74.2%), loop diuretics (- 83.3%), and aldosterone antagonists (- 80%). The mean office blood pressure in the intervention group increased (14.1 mmHg systolic and 6.9 mmHg diastolic), remaining below the target range (140/90 mmHg). The intervention group showed a significantly reduction in hypotensive symptoms than the control group (64.9% vs. 20%) (P < 0.001).

Conclusion: The data highlight an important role for pharmacists in optimizing hypertension management in older people. Deprescribing antihypertensives can limit symptomatic hypotension.

Trial registration: Registered on ClinicalTrials.gov under number NCT04861727.

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基层医疗机构对老年人停用降压药：MINOR 随机临床试验的分组分析。

背景：目的：评估药剂师通过家庭血压监测指导患有低血压的老年人停用降压药的情况：方法：对 MINOR 临床试验中出现低血压症状或体征的老年人分组进行分析。在 MINOR 程序中，为每位患者提供了一个设备，用于在家中进行为期一周的血压测量，然后生成报告并与药剂师（干预组）或家庭医生（对照组）共享。在干预组中，药剂师建议优化药物治疗；而在对照组中，则由家庭医生单独决定必要的治疗调整。结果分析了两组平均血压、有低血压症状/体征的患者以及降压药物处方的差异：对 72 名患者进行了评估（对照组 35 人；干预组 37 人）。干预组的药物处方明显减少（- 28.6%；P 结论：数据强调了药物治疗的重要作用：这些数据凸显了药剂师在优化老年人高血压管理方面的重要作用。减少抗高血压药的处方可以限制症状性低血压的发生：试验注册：已在 ClinicalTrials.gov 上注册，注册号为 NCT04861727。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Clinical Pharmacy PHARMACOLOGY & PHARMACY-

CiteScore

4.10

自引率

8.30%

发文量

131

审稿时长

4-8 weeks

期刊介绍： The International Journal of Clinical Pharmacy (IJCP) offers a platform for articles on research in Clinical Pharmacy, Pharmaceutical Care and related practice-oriented subjects in the pharmaceutical sciences. IJCP is a bi-monthly, international, peer-reviewed journal that publishes original research data, new ideas and discussions on pharmacotherapy and outcome research, clinical pharmacy, pharmacoepidemiology, pharmacoeconomics, the clinical use of medicines, medical devices and laboratory tests, information on medicines and medical devices information, pharmacy services research, medication management, other clinical aspects of pharmacy. IJCP publishes original Research articles, Review articles , Short research reports, Commentaries, book reviews, and Letters to the Editor. International Journal of Clinical Pharmacy is affiliated with the European Society of Clinical Pharmacy (ESCP). ESCP promotes practice and research in Clinical Pharmacy, especially in Europe. The general aim of the society is to advance education, practice and research in Clinical Pharmacy . Until 2010 the journal was called Pharmacy World & Science.