Improving the quality use of prescribed antihypertensive medications in the hospital setting

Abstract

Hypertension affects up to 70% of older persons. While there is strong evidence regarding the benefits of controlling blood pressure (BP) in older adults, less is known about the risks associated with the use of antihypertensive pharmacotherapy in older persons. This thesis investigates utilisation of antihypertensive medications; factors associated with BP control; impact of hospitalisation on antihypertensive medication use; and the prevalence of antihypertensive medication related adverse drug reactions (ADRs) in an older population. A large retrospective cross-sectional audit of 503 adults aged 65 years and older admitted to a large metropolitan teaching hospital was conducted. The majority of older persons with hypertension received antihypertensive pharmacotherapy. ADRs were the main reason for antihypertensive medication changes during hospitalisation. Use of antihypertensive medications was associated with an increased risk of ADRs, with older patients with renal impairment or recent changes to their antihypertensive medication regimens at the highest risk. In conclusion, while it is known that older persons are more sensitive to the pharmacological effects of antihypertensive medications, the high prevalence of potentially avoidable ADRs associated with these medications observed in this study calls for more research into strategies to prevent medication related harms in older persons.