☆ 4.7 Article

Characterising older adults' risk of harm from blood-pressure lowering medications: a sub-analysis from the PRIME study

AGE AND AGEING (2022)

Journal

AGE AND AGEING

Volume 51, Issue 3, Pages -

Publisher

OXFORD UNIV PRESS

DOI: 10.1093/ageing/afac045

Keywords

medication-related harm; cardiovascular disease; hypertension; polypharmacy; frailty; older people

Funding

National Institute for Health Research (NIHR)-Research for Patients Benefit Scheme [PB-PG-0711-25094]
Brighton and Sussex University Hospitals NHS Trust
National Institutes of Health Research (NIHR) [PB-PG-0711-25094] Funding Source: National Institutes of Health Research (NIHR)

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Abstract

The study found that polypharmacy with blood pressure-lowering drugs in older people is associated with preventable harm, highlighting the importance of carefully considering decisions around cardiovascular risk reduction.

Aim Cardiovascular disease (CVD) is common amongst frail older people. The evidence base for CVD commonly excludes older adults with multimorbidity or chronic conditions. Most cardiovascular drugs have the potential to lower blood pressure (BP) and therefore cause medication-related harm (MRH). We aimed to identify key clinical and sociodemographic characteristics associated with MRH in older people taking BP-lowering drugs for whatever indication they were prescribed. Methods The PRIME (prospective study to develop a model to stratify the risk of MRH in hospitalised elderly patients in the UK) study investigating the incidence and cost of MRH in older people across Southern England. Adults >= 65 years were recruited from five teaching hospitals at hospital discharge and followed up for 8 weeks. Telephone interviews with study participants, review of primary care records and hospital readmissions were undertaken to identify MRH. PRIME study participants taking BP-lowering drugs (as defined by National Institute for Health and Care Excellence hypertension guidelines) were included in this analysis. Results One hundred and four (12%) study patients experienced a total of 153 MRH events associated with BP-lowering drugs. Patients on four BP-lowering drugs were five times more likely to experience MRH compared to those taking one medication (OR 4.96; 95%CI 1.63-15.13; P = 0.01). Most MRH events were classified 'serious' (80%, n = 123), requiring dose change or treatment cessation. Almost half of MRH were potentially preventable (49%, n = 75). Conclusion Polypharmacy from BP-lowering drugs in older people is associated with preventable harm. Decisions around cardiovascular risk reduction should be carefully considered in view of MRH arising from BP-lowering drugs.

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Hospital pharmacists' opinions on a risk prediction tool for medication-related harm in older people

Ahmed Hussain, Khalid Ali, J. Graham Davies, Jennifer M. Stevenson, Samantha Lippett, Mairead O'Malley, Nikesh Parekh, Chakravarthi Rajkumar

Summary: This qualitative study explored the views of hospital pharmacists on the clinical implementation of the PRIME-RPT. It found that hospital pharmacists found the PRIME-RPT beneficial in identifying older patients at high risk of MRH following hospital discharge, facilitating prioritising interventions to those at highest risk while still acknowledging its limitations.

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY (2023)