Prescribing cascades in hypertension treatment with CCB (calcium channel blockers) (June 2020)
HYPERTENSION
Prescribing cascades
in hypertension treatment with CCB (calcium channel blockers) (June 2020)
To prescribe a
cascade may occur when an untoward drug side effect is misinterpreted as a new
medical sign and treated with a potentially unnecessary
drug. In a retrospective cohort report of more than 40,000 elderly
adults with HT, 1.4 % of ptns
prescribed a calcium channel blocker
were subsequently prescribed a loop diuretic agent within 90 d. compared with 0.7 % of ptns prescribed a different
anti-HT. Since the peripheral edema from CCB (calcium channel blockers) is due to fluid redistribution rather than fluid overload, ttt with a diuretic
is NOT currently
indicated and cn lead to adverse sequelae, for example, AKI (acute kidney injury), electrolyte imbalance, drop out, and urine incontinence, particularly in older ptns.
HYPERTENSION: Antihypertensive
medication dose reduction in older adults (July 2020)
Despite the reported
fact that most ptns with hypertension (HT)
should be maintained on lifelong antihypertensive drug therapy, some ptns, particularly elderly
adults, may be candidates for drug dose
reduction. In a 12-wk
randomized trial involving more than 600 adults aged ≥80
ys with systolic blood pressures <150
on multiple anti-HT, those exposed to
medication dose reduction had similar rates
of blood pressure optimization as those assigned to usual
care. However, a third of those in the intervention g. needed to hv an
anti-HT reinstated. Although this
trial was of short period and longer term
studies are needed, it supports drug dose
reduction in some ptns with HT, which may be an opportunity for deep
discussion and sharing decision making
between the treating physician and his patient.
COMMENTS