TY - JOUR
T1 - Antihypertensive treatment changes and related clinical outcomes in older hospitalized patients
AU - Giovani Internisti Società Italiana di Medicina Interna (GIS-SIMI) and of the REPOSI Investigators
AU - Cicco, Sebastiano
AU - D′Abbondanza, Marco
AU - Proietti, Marco
AU - Zaccone, Vincenzo
AU - Pes, Chiara
AU - Caradio, Federica
AU - Mattioli, Massimo
AU - Piano, Salvatore
AU - Marra, Alberto Maria
AU - Nobili, Alessandro
AU - Mannucci, Pier Mannuccio
AU - Pietrangelo, Antonello
AU - Sesti, Giorgio
AU - Buzzetti, Elena
AU - Salzano, Andrea
AU - Cimellaro, Antonio
AU - Perticone, Francesco
AU - Violi, Francesco
AU - Corazza, Gino Roberto
AU - Corrao, Salvatore
AU - Marengoni, Alessandra
AU - Salerno, Francesco
AU - Cesari, Matteo
AU - Tettamanti, Mauro
AU - Pasina, Luca
AU - Franchi, Carlotta
AU - Novella, Alessio
AU - Miglio, Gabriella
AU - Galbussera, Alessia Antonella
AU - Ardoino, Ilaria
AU - Prisco, Domenico
AU - Silvestri, Elena
AU - Emmi, Giacomo
AU - Bettiol, Alessandra
AU - Mattioli, Irene
AU - Biolo, Gianni
AU - Zanetti, Michela
AU - Bartelloni, Giacomo
AU - Zaccari, Michele
AU - Chiuch, Massimiliano
AU - Vanoli, Massimo
AU - Grignani, Giulia
AU - Pulixi, Edoardo Alessandro
AU - Pirro, Matteo
AU - Lupattelli, Graziana
AU - Bianconi, Vanessa
AU - Alcidi, Riccardo
AU - Pirisi, Mario
AU - Sola, Daniele
AU - Bellan, Mattia
N1 - Publisher Copyright:
© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Hypertension management in older patients represents a challenge, particularly when hospitalized. Objective: The objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients. Methods: A total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptor-blocker (ARB) with a calcium-channel-blocker (CCB) and/or a thiazide diuretic; if >80 years old, an ACE-I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all-cause death, cardiovascular (CV) hospitalization/death, CV death, non-CV death, evaluated according to the presence of MT at discharge. Results: Hypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all-cause death, all-cause death/hospitalization, CV death, CV death/hospitalization and non-CV death. Conclusions: Guidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in antihypertensive treatment still occur in a significant proportion of older hospitalized patients.
AB - Background: Hypertension management in older patients represents a challenge, particularly when hospitalized. Objective: The objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients. Methods: A total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptor-blocker (ARB) with a calcium-channel-blocker (CCB) and/or a thiazide diuretic; if >80 years old, an ACE-I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all-cause death, cardiovascular (CV) hospitalization/death, CV death, non-CV death, evaluated according to the presence of MT at discharge. Results: Hypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all-cause death, all-cause death/hospitalization, CV death, CV death/hospitalization and non-CV death. Conclusions: Guidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in antihypertensive treatment still occur in a significant proportion of older hospitalized patients.
KW - antihypertensive drugs
KW - cardiovascular events
KW - hypertension
KW - older patients
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85144355507&partnerID=8YFLogxK
U2 - 10.1111/eci.13931
DO - 10.1111/eci.13931
M3 - Article
SN - 0014-2972
VL - 53
JO - European Journal of Clinical Investigation
JF - European Journal of Clinical Investigation
IS - 4
M1 - e13931
ER -