Publications

Authors:

Cicco, Sebastiano; D Abbondanza, Marco; Proietti, Marco; Zaccone, Vincenzo; Pes, Chiara; Caradio, Federica; Mattioli, Massimo; Piano, Salvatore; Marra, Alberto Maria; Nobili, Alessandro; Mannucci, Pier Mannuccio; Pietrangelo, Antonello; Sesti, Giorgio; Buzzetti, Elena; Salzano, Andrea; Cimellaro, Antonio; Giovani Internisti Società Italiana di Medicina Interna (GIS-SIMI) and of the REPOSI, Investigators; Girelli, Domenico; Minuz, Pietro

Title:

Antihypertensive treatment changes and related clinical outcomes in older hospitalized patients

Year:

2023

Type of item:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Language:

Inglese

Format:

Elettronico

Referee:

No

Name of journal:

European Journal of Clinical Investigation

ISSN of journal:

0014-2972

N° Volume:

53

Number or Folder:

4

Page numbers:

1-10

Keyword:

antihypertensive drugs; cardiovascular events; hypertension; older patients; survival

Short description of contents:

Background: Hypertension management in older patients represents a challenge, particularly when hospitalized.Objective: The objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients.Methods: A total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptorblocker (ARB) with a calcium- channel-blocker (CCB) and/or a thiazide diuretic; if > 80 years old, an ACE I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all cause death, cardiovascular (CV) hospitalization/death, CV death, non CV death, evaluated according to the presence of MT at discharge.Results: Hypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all cause death, all cause death/hospitalization, CV death, CV death/hospitalization and non-CV death. Conclusions: Guidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in anti hypertensive treatment still occur in a significant proportion of older hospitalized patients.

Note:

Complete list of REPOSI Investigators and Giovani Internisti SIMI (GIS) is available in Appendix S2. Sebastiano Cicco, Marco D’Abbondanza, contributed equally to this article. Andrea Salzano, Antonio Cimellaro, joint senior authors.

Web page:

https://onlinelibrary.wiley.com/doi/10.1111/eci.13931

Product ID:

139579

Handle IRIS:

11562/1126267

Last Modified:

October 5, 2024

Bibliographic citation:

Cicco, Sebastiano; D Abbondanza, Marco; Proietti, Marco; Zaccone, Vincenzo; Pes, Chiara; Caradio, Federica; Mattioli, Massimo; Piano, Salvatore; Marra, Alberto Maria; Nobili, Alessandro; Mannucci, Pier Mannuccio; Pietrangelo, Antonello; Sesti, Giorgio; Buzzetti, Elena; Salzano, Andrea; Cimellaro, Antonio; Giovani Internisti Società Italiana di Medicina Interna (GIS-SIMI) and of the REPOSI, Investigators; Girelli, Domenico; Minuz, Pietro, Antihypertensive treatment changes and related clinical outcomes in older hospitalized patients «European Journal of Clinical Investigation» , vol. 53 , n. 4 , 2023 , pp. 1-10

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