title: Results of a pilot pharmacotherapy quality improvement program using fixed-dose, combination amlodipine/benazepril antihypertensive therapy in a long-term care setting.
abstract: BACKGROUND
  Hypertension is common in older adults (aged > or =65 years). Treatment frequently requires multiple medications and can be expensive.
  
  
  OBJECTIVE
  This study measured the impact of substituting low-dose, fixed-combination therapy using the calcium channel blocker (CCB) amlodipine and the angiotensin-converting enzyme (ACE) inhibitor benazepril for high-dose CCB monotherapy or dual therapy with a CCB and an ACE inhibitor on antihypertensive drug costs, the incidence of adverse events, and blood-pressure control.
  
  
  METHODS
  A multicenter, pilot pharmacotherapy quality improvement program was undertaken in a long-term care facility setting. Consultant pharmacists reviewed pharmacy records and medical charts from long-term care facilities, identifying older patients with a diagnosis of hypertension who either took CCB concomitantly with an ACE inhibitor or experienced adverse events on high-dose CCB therapy. Eligible patients were identified and their physicians contacted regarding switching them to fixed-dose combination therapy.
  
  
  RESULTS
  A total of 51 patients at 17 facilities were switched to fixed-dose amlodipine/benazepril combination therapy; 94.1% were women and 5.9% were men (mean age, 85.1 years; range, 64-99 years). The mean number of comorbidities was 1.6. During the subsequent 2 months, mean blood pressure remained at levels similar to those at baseline. The number of patients reporting at least 1 drug-related adverse event decreased by 81.8% (P < 0.05), and the incidence of edema decreased by 75.0%. The mean per-patient cost of antihypertensive drugs decreased by 33.1% (P < 0.001), a mean per-patient savings of 19.21 US dollars per month.
  
  
  CONCLUSIONS
  In patients aged > or =65 years with hypertension in long-term care facilities, a change from high-dose CCB monotherapy or CCB/ACE-inhibitor dual therapy to fixed-dose combination amlodipine/benazepril therapy significantly reduced drug costs and the incidence of adverse events and maintained blood-pressure control.
authors.affiliation: Christian Health Care Center, Wyckoff, New Jersey 07481, USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sapienza
authors.forename: Patricia
authors.initials: P
authors.lastname: Sacco
authors.forename: Kristine
authors.initials: K
authors.lastname: Floyd
authors.forename: Joseph
authors.initials: J
authors.lastname: DiCesare
authors.forename: QuynhChau Diem
authors.initials: QD
authors.lastname: Doan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017311:Amlodipine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001552:Benzazepines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001552:Benzazepines; D002121:Calcium Channel Blockers; D004338:Drug Combinations; D017311:Amlodipine; C044946:benazepril