Changes to Antihypertensive Therapy Regimens during the Hospitalisation of Elderly Inpatients — The Association Specialists
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Changes to Antihypertensive Therapy Regimens during the Hospitalisation of Elderly Inpatients (304)

Beata Bajorek 1 , Tariq Alhawassi 2 , Romano Fois 2 , Ines Krass 2 , Lisa Pont 3
  1. UTS & Royal North Shore Hospital, Broadway, NSW, Australia
  2. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
  3. Sydney Nursing School, University of Sydney, Sydney, NSW, Australia

Background
Hypertension is a common risk factor for cardiovascular disease. Therefore, optimal hypertension management is important, yet a significant proportion of elderly patients have poorly controlled blood pressure despite a plethora of antihypertensive medications.
Aims
To investigate the patterns of use, and changes, in antihypertensive medications during hospitalisation among the elderly.
Methods
A retrospective review of medical records for patients admitted to a large metropolitan teaching hospital was conducted. The cohort comprised a random sample of patients (n=503) aged ≥65 years admitted for ≥48 hours for any indication and taking at least one medicine. Demographic, clinical and medication regimen data were extracted.
Results
The mean age of study participants was 80.3 years (SD±8.2); 58.6% were female; mean length of admission was 10.2 days (SD±9.2). Most patients (69%, n= 347) had a documented history of hypertension and were admitted for non-cardiovascular conditions (84.5%). In those with a history of hypertension, information regarding BP control prior to admission was available for only 16.7%; on admission, only 37.5% had well-controlled BP. During hospitalisation 40.3% (n=140) of patients with hypertension experienced a change to their antihypertensive regimen, although 61.3% patients experienced BP perturbations: hypotensive 7.8% (n=27) or hypertensive 53.5% (n=185) episodes. Antihypertensives were ceased or dose reduced in 59.1%, and commenced or dose increased in 37.3% of patients. Out of the 75 patients who had a medication ceased on discharge, 43 experiences adverse drug reactions (57.3%). The other most common reasons for reducing therapy were adverse hypotension and renal function impairment.
Conclusions
Many elderly hypertension patients experienced modification to their antihypertensive regimen during hospitalisation despite a lack of information on previous long-term BP control. While many medication changes were in response to hypotensive or hypertensive episodes, a relatively large number of antihypertensive medications were ceased due to ADRs and these should be considered when reviewing management of hypertension, especially in the elderly.