DEPRESCRIBING AND PROGNOSIS IN OLDER PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC HEART FAILURE

Abstract

Objective: Treatment of older patients with arterial hypertension is complicated by comorbidity and frailty syndrome. Deprescribing is a possible option for comorbid patients. The aim of this study was to investigate deprescribing and prognosis in older hypertensive patients with chronic heart failure (CHF). Design and method: 119 older hypertensive patients with CHF (89 males, mean age was 68.9 ± 6.7 years) were studied. Arterial hypertension was defined according to ESC Guidelines for the diagnosis and treatment of arterial hypertension, 2018. Charlson comorbidity index (CCI) was estimated. Comorbidity was regarded as high at index more or equal 6 scores. Quality of life, frailty syndrome, personal characteristics were evaluated. GerontoNet ADR Risk Score was used for predicting ADRs. Follow-up period was 1 year, primary endpoint - all-cause mortality. Results: The CCI was 5.9 ± 1.9 scores. 67 (56.3%) older hypertensive patients with CHF had high comorbidity, 19 (10%) - frailty syndrome. The total number of drugs was 5 [4;7]. According to GerontoNet ADR Risk Score patients had 3 [2;4] scores. Most of patients (92;77.3%) had more than 5 scores (high risk of ADRs). Only 30 (25%) patients had high adherence to drug therapy. Patients with high comorbidity had more scores according to GerontoNet ADR Risk Score, than patients with low comorbidity (4 [3;6]. and 2 [1;4] resp., p = 0.0003). During the follow-up 13 patients died. The deceased patients compared to the surviving patients had a higher level of comorbidity (7.5 ± 1.9 and 5.8 ± 1.9 resp., p = 0.001)) and higher scores according to GerontoNet ADR Risk Score (4 [3;7]. and 3 [2;4] resp., p = 0.0006)). Relative risk of death within 12 months in older hypertension patients with CHF and high risk of adverse drug reactions (more or equal 6 scores according to GerontoNet ADR Risk Score) was 3.85 times (95% CI 1.42 - 10.48) higher risk of death in patients with low risk of ADRs. Conclusions: Older patients with arterial hypertension and CHF are characterized by high comorbidity, polypharmacy and low adherence to treatment. GerontoNet ADR Risk Score may be recommended for assessing prognosis in older hypertensive patients with CHF.