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. 2024 Apr 17:15:1360146.
doi: 10.3389/fphar.2024.1360146. eCollection 2024.

Developing practical recommendations for drug-disease interactions in patients with hypertension

Kübra Özokcu  1   2 , Maaike M E Diesveld  3 , Suzan G H Gipmans  4 , Laura E J Peeters  5 , Bert-Jan van den Born  6 , Sander D Borgsteede  3
Affiliations

Developing practical recommendations for drug-disease interactions in patients with hypertension

Kübra Özokcu et al. Front Pharmacol. .

Abstract

Background: Hypertension, a significant risk factor for cardiovascular diseases, demands proactive management as cardiovascular diseases remain the leading cause of death worldwide. Reducing systolic and diastolic blood pressure levels below recommended reference values of <140/90 mmHg can lead to a significant reduction of the risk of CVD and all-cause mortality. However, treatment of hypertension can be difficult and the presence of comorbidities could further complicate this treatment. Drugs used to manage these comorbidities may inadvertently have an impact on blood pressure, resulting in a phenomenon known as drug-disease interaction. This study aims to assess the safety of medication that can affect blood pressure in patients with hypertension and provide practical recommendations for healthcare professionals.

Methods: For the development of recommendations for the drug-disease interaction (DDSI) hypertension, a six-step plan that combined literature selection and multidisciplinary expert opinion was used. The process involved (1) defining the scope of the DDSI and selecting relevant drugs, (2) collecting evidence, (3) data-extraction, (4) reaching of expert consensus, (5) publication and implementation of the recommendations in healthcare systems and (6) updating the information.

Results: An increase of 10 mmHg in systolic blood pressure and 5 mmHg in diastolic blood pressure was defined as clinically relevant. Corticosteroids, danazol, and yohimbine caused a clinically relevant DDSI with hypertension. Several other drugs with warnings for hypertension in the official product information were assessed to have no clinically relevant DDSI due to minor influence or lack of data on blood pressure. Drugs with evidence for a relevant change in blood pressure which are prescribed under close monitoring of blood pressure according to clinical guidelines, were deemed to be not clinically relevant for signalling.

Conclusion: This study provides specific recommendations that can be implemented directly in clinical practice, for example, in clinical decision support systems, potentially resulting in safer drug use in patients with hypertension and better healthcare by reducing alert fatigue. Future research should focus on evaluating the effectiveness of implementation strategies and their impact on reducing unsafe use of medication in patients with hypertension.

Keywords: adverse drug reaction; blood pressure; clinical decision support; drug information; drug-disease interaction; hypertension; product information.

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Conflict of interest statement

MD and SB are employed at Health Base Foundation (HBF), an independent, non-commercial foundation that maintains a drug information database (Pharmabase) and supports health care professionals with a clinical decision support system. SG is employed at the Medicines information centre of the Royal Dutch Pharmacists Association (KNMP), an independent, non-commercial organization that maintains information on medication safety for a drug information database (G-Standaard) and thereby provides information for clinical decision support systems. The drug-disease interactions studied in this manuscript are subject to medical information provided by HBF and G-Standaard. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the six-step plan for evaluation of drug-disease interactions (DDSIs).
See this image and copyright information in PMC

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