Centro de Salud La Marina, Institut Català de la Salut, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Institut Català de la Salut, Barcelona, España.
Centro de Salud La Marina, Institut Català de la Salut, Barcelona, España.
Med Clin (Barc). 2018 Mar 23;150(6):220-223. doi: 10.1016/j.medcli.2017.06.061. Epub 2017 Sep 1.
To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment.
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.
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.
The proportion of patients with overtreatment is high. Changing good control criteria could contribute to a reasoned deprescription.
研究高血压且存在过度治疗的 80 岁以上老年患者的比例。
这是一项包含 281 名年龄均在 80 岁以上且处于原发性预防的老年患者的横断面模拟研究，这些患者的高血压均得到了良好的控制（收缩压<150mmHg，舒张压<90mmHg），且最多使用 3 种药物治疗。如果至少有一种药物可以去除且血压仍能得到良好控制，那么可以认为存在过度治疗，计算去除至少一种药物后血压升高的情况，这是通过 Law 的荟萃分析实现的，该分析根据治疗前的血压水平、药物的数量和剂量来估计血压降低。
患者的平均年龄为 85.3 岁（64.8%为女性）。服用一种药物的患者比例为 33.6%，服用两种药物的患者比例为 46.3%，服用三种药物的患者比例为 22.1%，最常开的药物为噻嗪类（69.4%）、ACEI（51.3%）、ARB（23.4%）、钙通道阻滞剂（21%）和β受体阻滞剂（19.6%）。过度治疗的比例为 90.7%，有 63.1%的患者可以去除两种药物，43.1%的患者可以去除三种药物。药物种类多（OR 2.47；95% CI 1.07-5.69；P=.033）与更有可能去除至少一种药物有关。
过度治疗的患者比例很高。改变良好控制的标准可能有助于合理减少药物的使用。
