Polypharmacy in Older Adults With Hypertension: A Comprehensive Review

Overview

Journal J Clin Hypertens (Greenwich)

Specialty Cardiology & Vascular Diseases

Date 2015 Jul 29

PMID 26215211

Citations 22

Authors

Bertrand N Mukete

Keith C Ferdinand

Affiliations

Soon will be listed here.

Abstract

Older adults are more likely to take more than two medications for medical conditions, and polypharmacy is associated with increased risk of adverse events (fall injury, hyperkalemia and hypokalemia, heart failure, and blood pressure exacerbation), polypharmacy mismanagement, drug-drug interaction, and increased costs. Knowledge of drugs that interact with known antihypertensive agents is paramount to avoiding or reducing adverse events, hospitalizations, and health care dollars. Innovative approaches such as use of a fixed-dose combination pill, ingestible sensor system, electronic reminder system, medical audits, and the integration of a pharmacist in the care of patients should be implemented to avoid polypharmacy mismanagement.

Citing Articles

Impact of Multimorbidity on Symptom Burden and Symptom Clusters in Patients Receiving Chemotherapy.

Harris C, Hammer M, Conley Y, Paul S, Cooper B, Shin J Cancer Med. 2025; 14(3):e70418.

PMID: 39910913 PMC: 11799588. DOI: 10.1002/cam4.70418.

Prognostic signature of multimorbidity, geriatric syndromes and resources cluster in older in- and outpatients: a pooled secondary analysis with a 6-month follow-up.

Stegemann J, Affeldt A, Muck L, Ferring A, Gerhards L, Pickert L BMJ Open. 2025; 14(12):e086975.

PMID: 39806651 PMC: 11667294. DOI: 10.1136/bmjopen-2024-086975.

The Polypharma Study: Association Between Diet and Amount of Prescription Drugs Among Seniors.

Dos Santos H, Gaio J, Durisic A, Beeson W, Alabadi A Am J Lifestyle Med. 2024; 18(6):813-819.

PMID: 39507922 PMC: 11536481. DOI: 10.1177/15598276211048812.

Adverse Drug Reactions of Cardiovascular Classes of Medicines-Data for Bulgarian Population.

Mitkova Z, Dimova A, Petrova G, Dimitrova M Biomedicines. 2024; 12(10).

PMID: 39457476 PMC: 11504719. DOI: 10.3390/biomedicines12102163.

Association of polypharmacy with clinical outcomes and healthcare utilization in older adults with cardiometabolic diseases: a retrospective cohort study.

Su S, Zhu X, Wu S, Ma W, Yan S, Zhang L Int J Clin Pharm. 2024; 47(1):80-89.

PMID: 39361166 DOI: 10.1007/s11096-024-01809-8.

References

. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2009; 31(12):2115-27. DOI: 10.1291/hypres.31.2115. View

Rastas S, Pirttila T, Viramo P, Verkkoniemi A, Halonen P, Juva K . Association between blood pressure and survival over 9 years in a general population aged 85 and older. J Am Geriatr Soc. 2006; 54(6):912-8. DOI: 10.1111/j.1532-5415.2006.00742.x. View

Sleight P . Smoking and hypertension. Clin Exp Hypertens. 1993; 15(6):1181-92. DOI: 10.3109/10641969309037104. View

Grebla R, Rodriguez C, Borrell L, Pickering T . Prevalence and determinants of isolated systolic hypertension among young adults: the 1999-2004 US National Health And Nutrition Examination Survey. J Hypertens. 2009; 28(1):15-23. PMC: 2891994. DOI: 10.1097/HJH.0b013e328331b7ff. View

Carlini R, Dusso A, Obialo C, Alvarez U, ROTHSTEIN M . Recombinant human erythropoietin (rHuEPO) increases endothelin-1 release by endothelial cells. Kidney Int. 1993; 43(5):1010-4. DOI: 10.1038/ki.1993.142. View

Gualtierotti R, Zoppi A, Mugellini A, Derosa G, DAngelo A, Fogari R . Effect of naproxen and acetaminophen on blood pressure lowering by ramipril, valsartan and aliskiren in hypertensive patients. Expert Opin Pharmacother. 2013; 14(14):1875-84. DOI: 10.1517/14656566.2013.816286. View

Bresalier R, Sandler R, Quan H, Bolognese J, Oxenius B, Horgan K . Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. 2005; 352(11):1092-102. DOI: 10.1056/NEJMoa050493. View

Dixon R, Meire H, Evans D, Watt H, On N, Posner J . Peripheral vascular effects and pharmacokinetics of the antimigraine compound, zolmitriptan, in combination with oral ergotamine in healthy volunteers. Cephalalgia. 1997; 17(6):639-46. DOI: 10.1046/j.1468-2982.1997.1706639.x. View

Sudano I, Flammer A, Periat D, Enseleit F, Hermann M, Wolfrum M . Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation. 2010; 122(18):1789-96. DOI: 10.1161/CIRCULATIONAHA.110.956490. View

10.

Wright Jr J, Fine L, Lackland D, Ogedegbe G, Himmelfarb C . Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014; 160(7):499-503. DOI: 10.7326/M13-2981. View

11.

Patterson S, Cadogan C, Kerse N, Cardwell C, Bradley M, Ryan C . Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014; (10):CD008165. DOI: 10.1002/14651858.CD008165.pub3. View

12.

Aronow W, Fleg J, Pepine C, Artinian N, Bakris G, Brown A . ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology,.... J Am Coll Cardiol. 2011; 57(20):2037-114. DOI: 10.1016/j.jacc.2011.01.008. View

13.

Wald D, Law M, Morris J, Bestwick J, Wald N . Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009; 122(3):290-300. DOI: 10.1016/j.amjmed.2008.09.038. View

14.

Egan B, Li J, Shatat I, Fuller J, Sinopoli A . Closing the gap in hypertension control between younger and older adults: National Health and Nutrition Examination Survey (NHANES) 1988 to 2010. Circulation. 2014; 129(20):2052-61. PMC: 4413456. DOI: 10.1161/CIRCULATIONAHA.113.007699. View

15.

Cushman W, Evans G, Byington R, Goff Jr D, Grimm Jr R, Cutler J . Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362(17):1575-85. PMC: 4123215. DOI: 10.1056/NEJMoa1001286. View

16.

Johnson A, Nguyen T, Williamson D, Day R . Potential mechanisms by which nonsteroidal anti-inflammatory drugs elevate blood pressure: the role of endothelin-1. J Hum Hypertens. 1996; 10(4):257-61. View

17.

James P, Oparil S, Carter B, Cushman W, Dennison-Himmelfarb C, Handler J . 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013; 311(5):507-20. DOI: 10.1001/jama.2013.284427. View

18.

Antman E, Bennett J, Daugherty A, Furberg C, Roberts H, Taubert K . Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007; 115(12):1634-42. DOI: 10.1161/CIRCULATIONAHA.106.181424. View

19.

Bitton A, Choudhry N, Matlin O, Swanton K, Shrank W . The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med. 2013; 126(4):357.e7-357.e27. DOI: 10.1016/j.amjmed.2012.09.004. View

20.

. MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party. Br Med J (Clin Res Ed). 1985; 291(6488):97-104. PMC: 1416260. DOI: 10.1136/bmj.291.6488.97. View