Silva Igor Matheus, Moreira Pablo Maciel, Santos Alessa Maria, Castro Priscila Ribeiro, Aguiar Erlan Canguçu, Oliveira Marcio Galvão
Programa de Pós-Graduação em Assistência Farmacêutica em Associação de Instituições de Ensino Superior, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Vitória da Conquista, BA, 45055-090, Brazil.
Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Candeias, Vitória da Conquista, BA, Brazil.
Int J Clin Pharm. 2025 Feb;47(1):53-59. doi: 10.1007/s11096-024-01805-y. Epub 2024 Nov 6.
Polypharmacy is often required for older adults with hypertension, and excessive treatment is associated with a high risk of adverse reactions, including hypotension.
To evaluate the deprescribing of antihypertensive medications guided by pharmacists using home blood pressure monitoring in older adults with hypotension.
A subgroup of older adults with signs or symptoms of hypotension, included in the MINOR clinical trial, was analysed. In the MINOR procedures, each patient was provided with a device to conduct blood pressure measurement at home for 1 week, following which a report was generated and shared with pharmacists (intervention group) or family physicians (control group). In the intervention group, a pharmacist suggested optimising pharmacotherapy; meanwhile, in the control group, a family physician alone determined the necessary treatment adjustments. Differences in mean blood pressure, the patients with symptoms/signs of hypotension, and the antihypertensive medication deprescribing between both groups were analysed.
Seventy-two patients were evaluated (35, control group; 37, intervention group). The intervention group showed a significant reduction in medication prescriptions (- 28.6%; P < 0.001), especially beta-blockers (- 74.2%), loop diuretics (- 83.3%), and aldosterone antagonists (- 80%). The mean office blood pressure in the intervention group increased (14.1 mmHg systolic and 6.9 mmHg diastolic), remaining below the target range (140/90 mmHg). The intervention group showed a significantly reduction in hypotensive symptoms than the control group (64.9% vs. 20%) (P < 0.001).
The data highlight an important role for pharmacists in optimizing hypertension management in older people. Deprescribing antihypertensives can limit symptomatic hypotension.
Registered on ClinicalTrials.gov under number NCT04861727.
老年高血压患者通常需要联合使用多种药物，过度治疗会带来包括低血压在内的高不良反应风险。
评估药师在家庭血压监测的指导下，对老年低血压患者停用降压药物的效果。
对纳入MINOR临床试验的有低血压体征或症状的老年患者亚组进行分析。在MINOR试验过程中，为每位患者提供一台设备，让其在家中进行1周的血压测量，之后生成报告并与药师（干预组）或家庭医生（对照组）分享。在干预组中，药师建议优化药物治疗；与此同时，在对照组中，仅由家庭医生确定必要的治疗调整。分析两组之间平均血压、有低血压症状/体征的患者以及停用降压药物情况的差异。
共评估了72例患者（35例在对照组；37例在干预组）。干预组的药物处方显著减少（-28.6%；P<0.001），尤其是β受体阻滞剂（-74.2%）、袢利尿剂（-83.3%）和醛固酮拮抗剂（-80%）。干预组的诊室平均血压升高（收缩压升高14.1mmHg，舒张压升高6.9mmHg），仍低于目标范围（140/90mmHg）。干预组的低血压症状比对照组显著减少（64.9%对20%）（P<0.001）。
数据突出了药师在优化老年人高血压管理中的重要作用。停用降压药物可限制症状性低血压。
在ClinicalTrials.gov上注册，注册号为NCT04861727。
