Prevalence and Clinical Impact of Polypharmacy in Geriatric Patients With Hypertension

Objective: Hypertension in older adults is frequently associated with multimorbidity, resulting in complex treatment regimens and a high prevalence of polypharmacy linked to adverse outcomes. This study assessed the prevalence of polypharmacy and its clinical impact in geriatric patients with hypertension. Design and method: All patients attending the outpatient clinic between June 2025 and January 2026 were screened, and those aged over 65 years with hypertension were included. Polypharmacy was defined as the concurrent use of at least 5 medications, and excessive polypharmacy as >10 medications. Study outcomes included acute kidney injury and electrolyte disturbances occurring within the preceding year. Results: A total of 147 patients (mean age 69.8±4.7 years) were included, of whom 55 (37.4%) were male. Polypharmacy was present in 78 patients (53.0%), while excessive polypharmacy was observed in 18 patients (12.2%). The median daily pill burden was 6 (range, 2–14). Comorbidities included diabetes in 57 patients (38.7%), coronary artery disease in 48 (32.6%), heart failure in 25 (17.0%), COPD in 18 (12.2%), hypothyroidism in 16 (10.8%), chronic kidney disease in 14 (9.5%), and atrial fibrillation in 8 (5.4%) patients. RAAS inhibitors were used in 96 patients (65.3%), calcium channel blockers in 62 (42.1%), diuretics in 49 (33.3%), beta-blockers in 44 (29.9%), MRAs in 21 (14.2%), and alpha-blockers in 10 (6.8%). The most frequently prescribed non-antihypertensive medications were oral antidiabetics (34.6%), NSAIDs (32.6%), and aspirin (29.2%). Resistant hypertension was identified in 42 patients (28.5%) and was significantly more prevalent among those with polypharmacy compared with those without (37.1% vs. 18.8%, p=0.014). Acute kidney injury occurred in 8 patients (5.4%) and hyponatremia in 6 patients (4.0%), with similar incidences between groups. Hyperkalemia occurred in 12 patients and tended to be more frequent among those with polypharmacy (11.5% vs. 4.3%, p=0.11). Hypokalemia was observed in 14 patients (9.5%) and was significantly more common in patients with polypharmacy (14.1% vs. 4.3%, p=0.04). Conclusions: Polypharmacy is common among geriatric patients with hypertension and is associated with increased resistant hypertension and electrolyte disturbances. These findings highlight the importance of regular medication review and individualized treatment strategies in older adults.