Key result
Very old age is linked to ~5% more antihypertensive monotherapy prescriptions compared to ages 65-79.
Why the study?
Elderly and very elderly individuals might be subject to different approaches for hypertension treatment, but comparative data on drug utilization and inappropriate prescribing in primary care are lacking.
Are there differences in antihypertensive drug utilization and potentially inappropriate prescribing between old (65-79 years) and very old (≥80 years) patients in primary care?
Cross-Sectional (n=568,067)
Yes
Are there differences in antihypertensive drug utilization and potentially inappropriate prescribing between old (65-79 years) and very old (≥80 years) patients in primary care?
Prescribing preferences for old and very old hypertensive patients show slight differences, with high rates of monotherapy and concerning use of potentially inappropriate medications like furosemide in the very elderly.
Modest age-group differences in monotherapy rates should not change practice; leaves open whether prescribing reflects appropriate tailoring in the very old.
BACKGROUND: Elderly and very elderly individuals might be subject to different approaches for the treatment of hypertension. We aimed to compare drug utilization in hypertensive old patients and very old patients in primary care, along with the evaluation of potentially inappropriate drug prescribing. METHODS: In this cross-sectional study, we compared prescriptions of 65-79-year-old (old patient prescriptions [OPP], n = 433,988) vs. ≥80-year-old (very old patient prescriptions [VOPP], n = 134,079) with "essential hypertension" diagnosis, issued by 3:1 systematically-sampled primary care physicians (n = 1431) in İstanbul throughout 2016. Drug utilization patterns and distribution of antihypertensives based on drug class and combination status were evaluated. Frequency of potentially inappropriate drugs per Beers Criteria were identified and compared. RESULTS: Antihypertensive monotherapy practice was less common in OPP than VOPP (43.3% vs. 45.3%; p < 0.001). In both groups,the most commonly prescribed drugs were beta-blockers for monotherapy (37.4% vs. 33.1%, p < 0.001) and thiazide diuretics for combined therapy (69.8% vs. 67.4%, p < 0.001). Metoprolol was the most commonly prescribed antihypertensive both in OPP and VOPP (15.3% vs. 14.8%). Furosemide was ranked 10th in OPP and 3rd in VOPP (2.7% vs. 5.5%). Cardiovascular system drugs were the most commonly encountered potentially inappropriate medications in both groups (263.9 vs. 283.4 per 10,000 prescriptions, p = 0.004). Regarding antihypertensive drugs, 2.2% of those in OPP and 2.4% of those in VOPP were identified as potentially inappropriate (p = 0.002). DISCUSSION: Prescribing preferences to old and very old patients mostly showed slight differences. Almost half of prescriptions comprising antihypertensive monotherapy might imply hesitancy to prescribe combinations. Overuse of risky drugs such as furosemide in both groups, especially in the very elderly, requires more attention.
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Çolak et al. (2023) conducted a cross-sectional in essential hypertension (n=568,067). Age 65-79 years vs. Age ≥80 years was evaluated on Antihypertensive monotherapy practice (p=<0.001). Antihypertensive monotherapy was slightly less common in prescriptions for old patients (65-79 years) compared to very old patients (≥80 years) (43.3% vs. 45.3%; p<0.001).
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