Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Curr Opin Nephrol Hypertens. 2011 Sep;20(5):449-56. doi: 10.1097/MNH.0b013e32834902ad.
We have reviewed the recent literature to describe the potential medication errors and adverse drug events (ADEs) associated with antihypertensives among older adults with chronic kidney disease (CKD).
Overall, few studies have been published describing ADEs in older adults with CKD. Several examined hyperkalemia associated with angiotensin-converting enzyme (ACE)-inhibitor/angiotensin II receptor blocker (ARB), diuretic (potassium-sparing), and β-blocker use. Additional studies described acute kidney injury (AKI) most commonly with ACE-inhibitor/ARB therapy. Finally, orthostatic hypotension was evaluated in those taking ACE-inhibitor/ARB, β-blocker, or calcium-channel blocker therapy. In the absence of robust literature examining these events in this understudied population, one must consider age-related antihypertensive pharmacokinetic/pharmacodynamic profiles concomitantly with the patient's comorbidities and other medications in order to minimize the risk for potential medication errors, drug-drug interactions, and ADEs.
Some of the most common ADEs associated with antihypertensive use in older adults with CKD include hyperkalemia, AKI, and orthostatic hypotension. Diligent monitoring of laboratory data, vital signs, and potential drug-drug interactions may mitigate serious ADEs caused by antihypertensives in this high-risk patient population.
我们回顾了近期文献，以描述慢性肾脏病（CKD）老年患者中降压药物相关的潜在用药错误和药物不良事件（ADE）。
总体而言，描述 CKD 老年患者 ADE 的研究较少。一些研究检查了与血管紧张素转换酶（ACE）抑制剂/血管紧张素 II 受体阻滞剂（ARB）、利尿剂（保钾）和β受体阻滞剂相关的高钾血症。其他研究描述了急性肾损伤（AKI），最常见于 ACE 抑制剂/ARB 治疗。最后，评估了服用 ACE 抑制剂/ARB、β受体阻滞剂或钙通道阻滞剂治疗的患者的体位性低血压。由于缺乏对这一研究不足人群中这些事件的有力文献，必须同时考虑年龄相关的降压药药代动力学/药效学特征、患者的合并症和其他药物，以最大程度降低潜在用药错误、药物相互作用和 ADE 的风险。
与 CKD 老年患者使用降压药相关的一些最常见的 ADE 包括高钾血症、AKI 和体位性低血压。仔细监测实验室数据、生命体征和潜在的药物相互作用可能会减轻该高危患者人群中降压药引起的严重 ADE。
