An additional drug or more of the same?

Because stepping up treatment for blood pressure can come with risks – whether it’s a drug interaction if a new drug is added, electrolyte imbalance with high doses, or fainting and fainting. of a fall if a person’s pressure becomes too low – such decisions should be taken with care.

This is the first time that a study has directly compared the effects of the two approaches, said the first author Carole E. Aubert, MD, M.Sc., general internist at the University of Bern in Switzerland who carried out a large part of research while she was an academic at the UM Institute for Health Policy and Innovation.

“There is more and more advice on approaches to start treatment in the elderly, but less on the next steps to scale up treatment, especially in an older and medically complex population that is generally not included. in clinical trials of hypertension drugs, ”she said. “How can we safely increase medication in a population that is already taking many medications for high blood pressure and other conditions.”

SEE ALSO: Approaching Blood Pressure in a New Way

“Treatment guidelines suggest starting treatment with multiple drugs, and clinicians are comfortable with a ‘start low and slow’ approach in older patients,” said lead author Lillian Min, MD. , MSHS. ”But these results show that in older patients, we also have the possibility of tailoring the choices of intensifying drug treatment for hypertension, according to the characteristics of each patient.

She continued, “Is the patient more likely to stick to a simpler diet? Then increase an existing drug. Or is the blood pressure very high and the clinician more concerned with lowering it? So consider starting a new drug now. Min is a geriatrician in the Division of Geriatrics and Palliative Care at Michigan Medicine, UM’s University Medical Center, and the VA Ann Arbor Health System Geriatric Research and Clinical Education Center.

For older people who are already taking a range of medications, the added complexity of having to take another type of pill may be too much. The risks of polypharmacy, a term for taking multiple drugs, are already well known from other research, Min said. In fact, Medicare covers an annual drug review with a pharmacist for many seniors who take many drugs.

The research was funded by the National Institute on Aging and the Veterans Health Administration. In addition to Aubert and Min, the research team included Jeremy B. Sussman, MD, MS; Timothy P. Hofer, MD, M.Sc .; William C. Cushman, MD; and Jin-Kyung Ha, PhD.

Cited article: “Addition of a new drug or dose maximization to intensify the treatment of hypertension in the elderly ”, Ann Med Intern. DOI: 10.7326 / M21-1456

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