Influence of hospitalisation on the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in elderly hypertensive patients.
OBJECTIVE
The underutilization of beneficial cardiovascular medications such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in the elderly patients continues to be a matter of concern. The aim of the presented study was to compare the prescription of ACEI and ARB in elderly hypertensive patients at the time of hospital admission and discharge and to identify patient-related factors which determine the prescription of ACEI/ARB.


METHODS
The study sample (n = 1111) was selected from 2,157 patients hospitalised at long-term care departments of three municipal hospitals during the period between January 1, 2008 and December 31, 2009 and included hypertensive patients aged ≥65 years suffering from myocardial infarction, heart failure, atrial fibrillation, diabetes mellitus or nephropathy.


RESULTS
In hypertensive patients with myocardial infarction, diabetes mellitus and nephropathy, a significant increase was found in the use of ACEI/ARB during hospitalisation. However, there was no similar change in the use of such medications during hospitalisation in patients with heart failure and atrial fibrillation. Age ≥85 years (OR = 0.59 and OR = 0.50 at hospital admission and discharge, respectively), depression (OR = 0.63 at hospital discharge) and the systolic blood pressure ≤115 mmHg (OR = 0.45 at hospital discharge) decreased the probability of ACEI/ARB prescription. On the other hand, increasing the number of evaluated co-morbid conditions increased the patient's likelihood of being an "ACEI/ARB user" (OR = 1.20 at hospital discharge).


CONCLUSIONS
Our study has identified a subset of elderly hypertensive patients (with heart failure, atrial fibrillation) in whom the use of ACEI/ARB could be improved.
Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia, wawruch@hotmail.com.
Martin
M
Wawruch
Veronika
V
Slezakova
Jan
J
Murin
Jan
J
Luha
Michal
M
Bozik
Tatiana
T
Leitmann
Magdalena
M
Kuzelova
Rashmi
R
Shah
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D015331:Cohort Studies; D048909:Diabetes Complications / Q000188:drug therapy; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D018154:Slovakia
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors