Factors involved in the discontinuation of antihypertensive drug therapy

Abstract

In a real life setting, discontinuation of antihypertensive treatment is affected in an opposite direction by a large number of factors: type of antihypertensive treatment, co-treatments, clinical conditions and even demographic characteristics of the geographical area where the patient lives. Knowledge of these factors may help the effort to reduce this phenomenon.

An Expert Opinion From the European Society of Hypertension–European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects

“…34 Además, el aumento de la cantidad de fármacos prescriptos puede incrementar la probabilidad de reacciones adversas al fármaco, reacciones medicamentosas y reacciones entre la enfermedad y el fárma-co, e interacciones en pacientes en quienes el uso de múltiples medicamentos es extremadamente común debido a la concomitancia frecuente de las enfermedades cardiovasculares y no cardiovasculares 35,36 Por último, se sabe que el aumento de la cantidad de fármacos prescriptos tiene un efecto negativo sobre el cumplimiento del tratamiento, un problema especialmente serio en los pacientes muy ancianos en quienes el cumplimiento del tratamiento (y errores en la toma de medicamentos prescriptos) puede verse afectado de manera negativa por la disfunción cognitiva y la demencia. 37 Debería considerarse la combinación de 2 antihipertensivos si la monoterapia no logra controlar la PA, pero únicamente si hay probabilidad de obtener beneficios al considerar el potencial efecto protector de la reducción de la PA frente al riesgo de la hipotensión y otros efectos adversos. Como ya se mencionó en las guías de la ESH/ESC de 2013 1 y en otras guías de práctica clínica, 8 el tratamiento antihipertensivo en octogenarios, en general, no debería exceder de 3 fármacos diferentes, a menos que la PA continuara sin poder controlarse o los pacientes cumplieran 80 años y estuvieran bajo un régimen farmacológico de más de 3 medicamentos iniciado con anterioridad, pero que continúa siendo un tratamiento bien tolerado.…”

“…35,36 Finally, an increased number of prescribed drugs is known to have a negative effect on adherence to treatment, an especially serious problem in very old patients in whom adherence (and errors in taking the prescribed medicines) may be adversely affected by cognitive dysfunction and dementia. 37 Combination of 2 antihypertensive drugs should be considered if monotherapy fails to control BP, but only if consideration of the potential protective effect of BP reduction versus the risk of hypotension and other adverse effects makes a benefit likely. As already mentioned in the 2013 ESH/ESC 1 and other guidelines, 8 antihypertensive treatment in octogenarians should in general not exceed 3 different medications, unless BP remains severely uncontrolled, or patients become 80 under an earlier initiated >3 drug regime, but still well-tolerated, treatment.…”

Blood pressure control and risk profile in poststroke survivors

“…Mancia et al [22], analyzing discontinuation of antihypertensive drug therapy in almost half a million new users of antihypertensive drugs in Lombardy, Italy, also found age-adjusted risk of discontinuation of antihypertensive treatment was lowest with angiotensin receptor blockers (ARBs) and ACE inhibitors. In our group of stroke survivors, ACE inhibitors were the most frequently used class of antihypertensive drugs, mostly in combination as monotherapy was not common.…”

Comparison of single-pill strategies first line in hypertension

“…In high cardiovascular risk hypertensive patients, for example, a faster BP control may be associated with a reduced number of events [4]. Furthermore, achieving BP control through a reduced number of treatment steps may have a favourable psychological impact on the patient, with a better long-term adherence to treatment [5,6], a more frequent BP control [7] and a persistently greater cardiovascular protection [8,9]. 3.…”