Treatment of Hypertension in Complex Older Adults: How Many Medications Are Needed?

Published on 2019-06-17T12:00:00Z (GMT) by
<div><p><b>Background:</b> Many older adults with hypertension receive multiple antihypertensives. It is unclear whether treatment with several antihypertensive classes results in greater cardiovascular benefits than fewer antihypertensive classes. <b>Objectives:</b> We investigated (a) the longitudinal associations between treatment with ≥ 3 versus 1-2 classes and death and major adverse cardiovascular events (MACE) and (b) whether these associations varied by the presence of mobility disability. <b>Methods:</b> We included 6,011 treated hypertensive adults ≥65 from the Medical Expenditure Panel Survey (MEPS), a nationally representative community sample. Times to MACE and death were compared between those receiving ≥3 versus 1-2 classes using multivariable proportional hazards regression. We used inverse probability of treatment weighting to account for indication and contraindication bias. <b>Results:</b> There were no significant differences in the risk of mortality (hazard ratio [HR] = 0.96, <i>p</i> = .769) or MACE (HR = 1.10, <i>p</i> = .574) between the exposure groups, and there were no significant exposure × mobility disability interactions. <b>Discussion:</b> We found no benefit of ≥3 versus 1-2 antihypertensive classes in reducing mortality and cardiovascular events in a representative cohort of older adults, raising concern about the added benefit of additional antihypertensives in the real world.</p></div>

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Ouellet, Gregory M.; McAvay, Gail; Murphy, Terrence E.; E. Tinetti, Mary (2019): Treatment of Hypertension in Complex Older Adults: How Many Medications Are Needed?. SAGE Journals. Collection. https://doi.org/10.25384/SAGE.c.4545671.v1