Gulla Christine, Flo Elisabeth, Kjome Reidun Ls, Husebo Bettina S
Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Norway.
Department of Clinical Psychology, University of Bergen, Norway.
J Geriatr Cardiol. 2018 Apr;15(4):275-283. doi: 10.11909/j.issn.1671-5411.2018.04.011.
It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing.
From August 2014 to December 2015, 765 patients from 72 units (clusters) in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment ( = 295, 39%) were randomized to systematic medication review where the physician received support from peers (collegial mentoring) or were given care as usual (control condition). Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm.
At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group ( = 43, 32%) compared to control ( = 11, 10%); Incidence Rate Ratio = 0.8, 95% CI = 0.7-0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values (mean 134 mmHg). Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four ( = 0.031) and nine ( = 0.041).
A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.
使用降压药物治疗患有多种疾病的养老院患者是否能产生有益效果存在争议。大多数心血管疾病指南提倡进行治疗；但对于在治疗可能不再必要时如何减药，几乎没有相关建议。我们调查了药物评估对降压药物使用的影响以及认知、血压和处方之间的关联。
从2014年8月至2015年12月，来自挪威32家养老院72个单元（群组）的765名患者被纳入一项为期4个月的多中心群组随机对照试验，并进行9个月的随访。年龄≥65岁且正在接受降压治疗的患者（n = 295，39%）被随机分为两组，一组接受系统的药物评估，医生在评估过程中会得到同行的支持（同行指导），另一组则接受常规护理（对照）。观察指标包括降压药物的数量、收缩压和脉搏。我们将住院和死亡情况作为评估危害的标准。
在基线时，每位患者平均使用9.
