Multiple antihypertensive use and risk of mortality in residents of aged care services: a prospective cohort study
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ORIGINAL ARTICLE
Multiple antihypertensive use and risk of mortality in residents of aged care services: a prospective cohort study Miriam Kerry1,2 · J. Simon Bell1,3,4,5 · Claire Keen1 · Janet K. Sluggett1,3 · Jenni Ilomäki1 · Natali Jokanovic1 · Tina Cooper6 · Leonie Robson6 · Edwin C. K. Tan1,7,8 Received: 2 June 2019 / Accepted: 21 August 2019 © Springer Nature Switzerland AG 2019
Abstract Aims The objective of this study is to investigate the association between multiple antihypertensive use and mortality in residents with diagnosed hypertension, and whether dementia and frailty modify this association. Methods This is a two-year prospective cohort study of 239 residents with diagnosed hypertension receiving antihypertensive therapy across six residential aged care services in South Australia. Data were obtained from electronic medical records, medication charts and validated assessments. The primary outcome was all-cause mortality and the secondary outcome was cardiovascular-related hospitalizations. Inverse probability weighted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Covariates included age, sex, dementia severity, frailty status, Charlson’s comorbidity index and cardiovascular comorbidities. Results The study sample (mean age of 88.1 ± 6.3 years; 79% female) included 70 (29.3%) residents using one antihypertensive and 169 (70.7%) residents using multiple antihypertensives. The crude incidence rates for death were higher in residents using multiple antihypertensives compared with residents using monotherapy (251 and 173/1000 person-years, respectively). After weighting, residents who used multiple antihypertensives had a greater risk of mortality compared with monotherapy (HR 1.40, 95%CI 1.03–1.92). After stratifying by dementia diagnosis and frailty status, the risk only remained significant in residents with diagnosed dementia (HR 1.91, 95%CI 1.20–3.04) and who were most frail (HR 2.52, 95%CI 1.13–5.64). Rate of cardiovascular-related hospitalizations did not differ among residents using multiple compared to monotherapy (rate ratio 0.73, 95%CI 0.32–1.67). Conclusions Multiple antihypertensive use is associated with an increased risk of mortality in residents with diagnosed hypertension, particularly in residents with dementia and among those who are most frail. Keywords Antihypertensive agents · Hypertension · Mortality · Nursing homes · Residential facilities · Long-term care
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-019-01336-x) contains supplementary material, which is available to authorized users. * Edwin C. K. Tan [email protected] 1
2
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia School of Pharmacy, University of Nottingham, Nottingham, UK
3
NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
4
School of Pharmacy and
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