Sobretratamiento antihipertensivo en mayores de 80 años / Antihypertensive overtreatment in people 80 years old and older

Fundamento y objetivo: Estudiar la proporción de pacientes mayores de 80 años con hipertensión arterial y sobretratamiento farmacológico. Pacientes y métodos: Estudio de simulación, descriptivo transversal, incluyendo 281 pacientes mayores de 80 años de prevención primaria, seleccionados aleatoriamente, con buen control (presión arterial sistólica<150mmHg, presión arterial diastólica<90mmHg), tratados con 3 principios activos como máximo. Se consideró sobretratamiento si se podía retirar al menos un principio activo y persistía el buen control, calculando cuánto subiría la presión con el metaanálisis de Law, que estima las reducciones de presión arterial según pretratamiento, número y dosis del principio activo. Resultados: La edad media fue de 85,3 años (64,8% mujeres). Tomaban un principio activo el 33,6%, 2 el 46,3% y 3 el 22,1%, siendo los más prescritos tiazidas (69,4%), IECA (51,3%), ARA-II(23,4%), antagonistas del calcio (21%) y betabloqueantes (19,6%). El sobretratamiento fue del 90,7%, pudiéndose retirar 2 principios activos en un 63,1% y 3 en el 43,1%. La polifarmacia (OR 2,47; IC 95% 1,07-5,69; p=0,033) se asoció a una probable retirada de al menos un principio activo. Conclusiones: La proporción de pacientes con sobretratamiento es elevada. El cambio de criterios de control puede contribuir a una deprescripción razonada (AU)

Background and objective: To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment. Patients and methods: Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications. Results: The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication. Conclusions: The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription (AU)

Antihypertensive overtreatment in people 80 years old and older. / Sobretratamiento antihipertensivo en mayores de 80 años.

BACKGROUND AND OBJECTIVE: To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment. PATIENTS AND METHODS: Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications. RESULTS: The average age was 85.3 years (64.8% women). A percentage of 33.6 were taking one medication, 46.3% 2 and 22.1% 3, with the most prescribed being thiazides (69.4%), ACE inhibitors (51.3%), ARBs (23.4%), calcium antagonists (21%) and beta blockers (19.6%). Overtreatment was 90.7%, with 2 medications being able to be removed in 63.1% of cases and 3 in 43.1%. Polypharmacy (OR 2.47; 95% CI 1.07-5.69; P=.033) was associated with a greater likely removal of at least one medication. CONCLUSIONS: The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription.