Polypharmacy in the Aging Patient

Bénétos, Athanase; Rossignol, Patrick; Cherubini, Antonio; Joly, Laure; Grodzicki, Tomasz; Rajkumar, Chakravarthi; Strandberg, Timo; Petrovic, Mirko

doi:10.1001/jama.2015.7517

Cited by 122 publications

(54 citation statements)

References 91 publications

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“…The evidence among older adults is much weaker. In frail or multimorbid patients, lowering BP could cause harm [10]. Facilities for diagnosis and treatment should be availableScreening and diagnosis are usually done by primary care physicians.…”

Section: Measurement Of Blood Pressure and Screening For Hypertensionmentioning

confidence: 99%

“…While these patients are at very high risk for CVD, there are doubts about a true benefit of BP lowering drugs on mortality and other health outcomes. Instead of being beneficial, a low BP might indeed be detrimental among oldest-old patients [10]. …”

Section: Measurement Of Blood Pressure and Screening For Hypertensionmentioning

confidence: 99%

“…Patient selection in clinical trialsRCTs might select participants in better health, with fewer comorbidities, and with a longer life expectancy than participants in population-based cohort studies, with the latter being more representative of the general population. For instance, HYVET and SPRINT trials have well-defined and restrictive eligibility criteria for participants, who are healthier than the general population of the same age [10]. Post-randomization confounding may also bias results of trials [62].…”

Section: Blood Pressure and Related Outcomes: Evidence From Trials Anmentioning

confidence: 99%

“…Low BP in old and frail individuals might indeed cause hypo-perfusion of vital organs and accelerate physical and mental decline [11], a state of physiological weakness, which is often worsened by the presence of polypharmacy and comorbidity [10, 53]. Some authors suggest that the presence of frailty or other indicators of poor health might be an argument for deprescribing antihypertensive treatments (Table 5) [10, 24]. …”

Section: Blood Pressure and Related Outcomes: Evidence From Trials Anmentioning

confidence: 99%

“…Few trials have been conducted in this population [6–9], especially among the oldest-old, i.e., aged above 80 years. Further, there are conflicting observations about the relationship between BP and health outcomes among older adults, some cohort studies having shown that low BP could be detrimental especially among the oldest frail or multimorbid adults [10, 11]. …”

Section: Introductionmentioning

confidence: 99%

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Screening and treatment of hypertension in older adults: less is more?

et al. 2018

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Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.

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Section: Measurement Of Blood Pressure and Screening For Hypertensionmentioning

confidence: 99%

Section: Measurement Of Blood Pressure and Screening For Hypertensionmentioning

confidence: 99%

Section: Blood Pressure and Related Outcomes: Evidence From Trials Anmentioning

confidence: 99%

Section: Blood Pressure and Related Outcomes: Evidence From Trials Anmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening and treatment of hypertension in older adults: less is more?

et al. 2018

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Incorrect Trial Description, Reference Numbering, and Case Description

2015

JAMA

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As we stated in our Viewpoint, we believe that targeted measurement of 25(OH)D in patients at high risk of vitamin D deficiency and those with bone health disorders remains appropriate, and such patients may benefit from high-dose vitamin D supplementation. 1,3 These decisions are at the discretion of the clinician and in no way conflict with the population-level, public-health orientation of the IOM and USPSTF.Ongoing large randomized trials of higher doses of vitamin D are important for determining the overall benefitrisk balance of such supplementation in the general population. Widespread vitamin D screening for no clear indication may make it difficult for these trials to obtain definitive answers. There may be harm associated with uninformative results: in the past, hypothesized benefits of megadose nutritional supplementation have not always been confirmed in large randomized trials and adverse effects have been identified.The ongoing VITamin D and OmegA-3 TriaL (VITAL) is testing 2000 IU/day of vitamin D for the primary prevention of cancer and cardiovascular disease in 25 874 US adults. 3 Background intake and/or supplementation up to the RDA is encouraged; thus, no participant would be expected to become vitamin D deficient as a result of study participation, even if randomized to receive placebo. Nearly 17 000 VITAL participants have provided baseline blood samples, which will allow for assessment of the effectiveness of the intervention according to baseline 25(OH)D levels.We would add 1 word to Plotnikoff's conclusion: "…clinical caution means targeted measurement of and rational supplementation with vitamin D."

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Measurement Methodology: What Does Blood Pressure Mean in the PARTAGE Study?—Reply

Bénétos

Rossignol

2015

JAMA Intern Med

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Polypharmacy in the Aging Patient

Cited by 122 publications

References 91 publications

Screening and treatment of hypertension in older adults: less is more?

Screening and treatment of hypertension in older adults: less is more?

Incorrect Trial Description, Reference Numbering, and Case Description

Measurement Methodology: What Does Blood Pressure Mean in the PARTAGE Study?—Reply

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