Pharmacoepidemiological analysis of antihypertensive therapy in older age groups with senile asthenia syndrome

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Abstract

Aim. To conduct a pharmacoepidemiological study to determine the characteristics of antihypertensive therapy in older patients with senile asthenia syndrome (SSA) and compliance of this therapy with modern clinical recommendations.

Materials and methods. The study included 146 patients diagnosed with stage I–III hypertension who underwent inpatient treatment in the therapeutic department of the Krasnoyarsk Regional Hospital for War Veterans, the subjects were divided into two groups. The first group included 55 elderly patients (WHO, 2012) with hypertension and SSA. The second group included 35 elderly patients (WHO, 2012) with hypertension and SSA. The comparison group consisted of 56 patients aged 60 to 84 years with hypertension without SSA. Evaluation of the pharmacotherapy was carried out based on extracts from the medical histories of inpatient patients.

Results. The most commonly taken groups of antihypertensive drugs in patients of older age groups with hypertension and SSA according to the study are diuretics and β-blockers. Diuretics were taken by 88.6% of elderly patients and 83.6% of senile patients. The main combinations of antihypertensive drugs in patients with hypertension and SSA were: a two-component scheme of combination of an ACE inhibitor and a diuretic, a three-component scheme of combination of an ACE inhibitor, a β-blocker and a diuretic, four-component schemes of combination of an ACE inhibitor, a β-blocker, a calcium channel blocker and a diuretic, as well as a combination of an angiotensin II receptor blocker, a β-blocker, calcium channel blocker and diuretic with combined medications.

Conclusion. The prescribed antihypertensive therapy in patients of older age groups with hypertension and SSA in most cases is represented by a combination of several drugs. Many patients take three-component antihypertensive therapy regimens. There were no statistically significant differences between patients of older age groups with hypertension and SSA, as well as patients of older age groups with hypertension without SSA. Therefore, it can be concluded that the presence of senile asthenia syndrome does not affect the tactics of treatment of hypertension and regardless of the presence or presence of SSA, patients receive the same hypotensive therapy, which contradicts existing clinical guidelines.

About the authors

Evgeny L. Davidov

Voyno-Yasenetsky Krasnoyarsk State Medical University

Author for correspondence.
Email: devgenii@bk.ru
ORCID iD: 0000-0001-7765-2726

д-р мед. наук, доц., доц. каф. пропедевтики внутренних болезней и терапии с курсом ПО ФГБОУ ВО «КрасГМУ им. проф. В.Ф. Войно-Ясенецкого»

Russian Federation, Krasnoyarsk

Roman A. Yaskevich

Voyno-Yasenetsky Krasnoyarsk State Medical University; Research Institute of Medical Problems of the North – a separate division of Federal Research Center “Krasnoyarsk Scientific Center” Siberian Branch of the Russian Academy of Sciences

Email: devgenii@bk.ru
ORCID iD: 0000-0003-4033-3697

д-р мед. наук, доц., доц. каф. пропедевтики внутренних болезней и терапии с курсом ПО ФГБОУ ВО «КрасГМУ им. проф. В.Ф. Войно-Ясенецкого», вед. науч. сотр. Научно-исследовательского института медицинских проблем Севера – обособленного подразделения ФГБНУ ФИЦ КНЦ СО РАН

Russian Federation, Krasnoyarsk; Krasnoyarsk

References

  1. Котовская Ю.В., Ткачева О.Н. Артериальная гипертензия у пациентов старших возрастных групп: когда и кому нужен гериатрический подход? Артериальная гипертензия. 2019;25(4):357-75 [Kotovskaya YuV, Tkacheva ON. Arterial hypertension in patients of older age groups: when and who needs a geriatric approach? Arterial`naya gipertenziya. 2019;25(4):357-75 (in Russian)]. doi: 10.18705/1607-419X-2019-25-4-357-375
  2. Parekh N, Page A, Ali K, et al. A practical approach to the pharmacological management of hypertension in older people. Ther Adv Drug Saf. 2017;8(4):117-32. doi: 10.1177/2042098616682721
  3. Kang M, Kim S, Yoon SJ, et al. Association between Frailty and Hypertension Prevalence, Treatment, and Control in the Elderly Korean Population. Sci Rep. 2017;7:7542. doi: 10.1038/s41598-017-07449-5
  4. Голованова Е.Д. Пациенты с полиморбидностью и старческой астенией – особенности медикаментозной терапии. Клиническая геронтология. 2019;25(7-8):39-43 [Golovanova ED. Patients with polymorbidity and senile asthenia – features of drug therapy. Klinicheskaya gerontologiya. 2019;25(7-8):39-43 (in Russian)]. doi: 10.26347/1607-2499201907-08039-043
  5. Ткачева О.Н., Остапенко В.С., Рунихина Н.К., Котовская Ю.В. Особенности антигипертензивной терапии и ее эффективность у амбулаторных пациентов пожилого и старческого возраста. Кардиология. 2016;11:50-4 [Tkacheva ON, Ostapenko VS, Runikhina NK, Kotovskaya YuV. Features of antihypertensive therapy and its effectiveness in outpatient patients of elderly and senile age. Kardiologiya. 2016;11:50-4 [(in Russian)]. doi: 10.18565/cardio.2016.11.50-54
  6. Ткачева О.Н., Переверзев А.П., Рунихина Н. К., и др. Современный подход к оптимизации лекарственных назначений у пациентов пожилого и старческого возраста. Клиническая геронтология. 2018;24(3-4):3-77 [Tkacheva ON, Pereverzev AP, Runikhina NK, et al. A modern approach to optimizing drug prescriptions in elderly and senile patients. Klinicheskaya gerontologiya. 2018;24(3-4):3-77 (in Russian)]. doi: 10.26347/1607-2499201803-04073-077
  7. Кобалава Ж.Д., Конради А.О., Недогода С.В., и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786 [Kobalava ZhD, Konradi AO, Nedogoda SV, et al. Clinical recommendations for the treatment of arterial hypertension in adults. Russian Journal of Cardiology. 2020;25(3):3786 (in Russian)]. doi: 10.15829/1560-4071-2020-3-3786
  8. Anker D, Santos-Eggimann B, Santschi V, et al. Screening and treatment of hypertension in older adults: less is more? Public Health Rev. 2018;39:26. doi: 10.1186/s40985-018-0101-z
  9. Кисляк О.А. Ингибитор АПФ лизиноприл в лечении пожилых пациентов с изолированной систолической и систоло-диастолической артериальной гипертензией. Лечебное дело. 2007;2:43-50 [Kislyak OA. ACE inhibitor lisinopril in the treatment of elderly patients with isolated systolic and systolic-diastolic arterial hypertension. Lechebnoe delo. 2007;2:43-50 (in Russian)].
  10. Лузина А.В., Ткачева О.Н., Рунихина Н.К. Антигипертензивная терапия у пациентки с синдромом старческой астении. Клинический случай. Доктор.Ру. 2019;2(157):23-6 [Luzina AV, Tkachyova ON, Runikhina NK. Antihypertensive therapy in a patient with senile asthenia syndrome. A case report. Doktor.Ru. 2019;2(157):23-6 (in Russian)]. doi: 10.31550/1727-2378-2019-157-2-23-26
  11. Ткачева О.Н., Рунихина Н.К., Котовская Ю.В., и др. Лечение артериальной гипертонии у пациентов 80 лет и старше и пациентов со старческой астенией. Кардиоваскулярная терапия и профилактика. 2017;16(1):8-21 [Tkacheva ON, Runikhina NK, Kotovskaya YuV, et al. Treatment of arterial hypertension in patients 80 years and older and patients with senile asthenia. Kardiovaskulyarnaya terapiya i profilaktika. 2017;16(1):8-21 (in Russian)]. doi: 10.15829/1728-8800-2017-1-8-21
  12. Mühlbauer V, Dallmeier D, Brefka S, et al. The Pharmacological Treatment of Arterial Hypertension in Frail, Older Patients – a Systematic Review. Dtsch Arztebl Int. 2019;116(3):23-30. doi: 10.3238/arztebl.2019.0023
  13. Ушакова С.Е., Александров М.В., Пайкова А.С. Нарушение артериального давления в ортостазе у пациентов старших возрастных групп на фоне гипотензивной терапии. Вестник ВГМУ. 2020;19(1):36-44 [Ushakova SE, Aleksandrov MV, Pajkova AS. Violation of arterial pressure in orthostasis in patients of older age groups on the background of hypotensive therapy. Vestnik VGMU. 2020;19(1):36-44 (in Russian)]. doi: 10.22263/2312-4156.2020.1.36
  14. Warwick J, Falaschetti E, Rockwood K, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med. 2015;13:78. doi: 10.1186/s12916-015-0328-1
  15. Vögele A, Johansson T, Renom-Guiteras A, et al. Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing. BMC Geriatr. 2017;17(Suppl. 1):224. doi: 10.1186/s12877-017-0575-4
  16. Umemura S, Arima H, Arima S, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42(9):1235-481. doi: 10.1038/s41440-019-0284-9
  17. Bakris GL, Sarafidis PA, Weir MR, et al. Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet. 2010;375(9721):1173-81. doi: 10.1016/S0140-6736(09)62100-0
  18. Rakugi H, Ogihara T, Saruta T, et al. Preferable effects of olmesartan/calcium channel blocker to olmesartan/diuretic on blood pressure variability in very elderly hypertension: COLM study subanalysis. J Hypertens. 2015;33(10):2165-72. doi: 10.1097/HJH.0000000000000668
  19. Gutiérrez-Valencia M, Izquierdo M, Cesari M, et al. The relationship between frailty and polypharmacy in older people: A systematic review. Br J Clin Pharmacol. 2018;84(7):1432-44. doi: 10.1111/bcp.13590
  20. Бельдиев С.Н., Медведева И.В., Платонов Д.Ю., Труфанова П.Ю. Исследования антикоагулянтной терапии у «хрупких» пожилых пациентов: проблемы терминологии и методологии. Рациональная фармакотерапия в кардиологии. 2019;15(2):251-7 [Bel`diev SN, Medvedeva IV, Platonov DYu, Trufanova PYu. Studies of anticoagulant therapy in “fragile” elderly patients: problems of terminology and methodology. Racional`naia Farmakoterapiia v Kardiologii. 2019;15(2):251-7 (in Russian)]. doi: 10.20996/1819-6446-201 9-15-2-251-257
  21. Харьков Е.И., Давыдов Е.Л., Шульмин А.В. Пожилой пациент и артериальная гипертония: особенности течения и терапии (сообщение II). Сибирское медицинское обозрение. 2010;65(5):3-7 [Khar`kov EI, Davy`dov EL, Shul`min AV. Elderly patient and arterial hypertension: features of the course and therapy of the message II. Sibirskoe medicinskoe obozrenie. 2010;65(5):3-7 (in Russian)].

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