[Antihypertensive drug treatment and renal function in geriatric emergency patients]

Abstract

Objective: The aim of this study was to assess drug prescriptions and renal function in a cohort of geriatric emergency patients with a focus on antihypertensive drug treatment.

Patients and methods: The one-year observational study was conducted among patients from nursing and retirement homes or outpatient care who were treated by the emergency medical service. Overall, 109 patients (85 women, mean age 85+/-8 years) were studied. Glomerular filtration rate was estimated (eGFR) on the basis of creatinine and cystatin C serum concentrations.

Results: The most common emergency admission diagnosis was syncope (n = 23), while the most common clinical diagnoses were dementia (n = 61) and hypertension (n = 60). Overall, 603 drugs were prescribed (mean 5.5 +/- 3, range 0 - 13), with 65 patients (60 %) receiving >/= 5 drugs per day. Of 60 patients with the known diagnosis of hypertension 55 (92 %) were being treated, while 71 % received at least 2 antihypertensive drugs. ACE-inhibitors (n = 33), loop diuretics (n = 28), beta-blockers (n = 22) and hydrochlorothiazide (n = 15) were the most frequently prescribed drugs. Mean creatinine (1.33 +/- 0.66 mg/dl) and cystatin C (1.78 +/- 0.83 mg/l) concentrations were elevated. Overall, up to two thirds of patients had eGFR values of < 60 ml/min/1.73 m (2). In up to 31 % of patients dosages were too high in relation to renal dysfunction.

Conclusions: The prescription of antihypertensive drugs contributes significantly to polypharmacy in geriatric emergency patients. About two thirds of these patients had clinically relevant impairment of renal function. The latter, together with the high number of prescribed drugs, may expose geriatric patients to an increased risk of adverse drug reactions requiring emergency treatment.