Earl J Morris1, Joshua D Brown1,2, Todd M Manini2,3, Scott M Vouri4,5,6. 1. Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA. 2. Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA. 3. Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, USA. 4. Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Dr, Gainesville, FL, 32610, USA. svouri@ufl.edu. 5. Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA. svouri@ufl.edu. 6. Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, USA. svouri@ufl.edu.
Abstract
BACKGROUND: Dihydropyridine calcium channel blockers (DH CCBs) are commonly used for hypertension in older adults. However, loop diuretics can be inappropriately added to treat DH CCB-induced edema, putting individuals at increased risk for adverse events and potential decreases in quality of life. METHODS: We conducted a cross-sectional analysis using United States Medical Expenditure Panel Survey (MEPS) data from 2003 to 2015. Adults aged ≥ 55 years without congestive heart failure, nephrotic syndrome, chronic kidney disease, renal failure, and cirrhosis who had consecutive rounds of DH CCB use (round 1 and 2 or round 3 and 4) and completed the self-administered questionnaire (SAQ) were included. Patients initiated on loop diuretics in round 2 or 4 were compared to those not initiated. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed using multivariable linear regression models. RESULTS: Among 5,458,467 DH CCB users (weighted), 3.4% of individuals were identified with new loop diuretic use (185,130 weighted). After adjusting for covariates, DH CCB plus loop diuretic use was associated with a PCS score 3.12 units lower (95% confidence interval - 5.40 to - 0.83; p = 0.008) than DH CCB use alone. We observed no significant difference in MCS score (p = 0.160) among DH CCB plus loop diuretic users compared to DH CCB users alone. CONCLUSIONS: New loop diuretic use was associated with lower physical functioning among DH CCB users. These findings suggest that this potential prescribing cascade may result in both significant and clinically meaningful decreases in health-related quality of life. It is important for clinicians to avoid or intervene on this inappropriate prescribing cascade when possible.
BACKGROUND:Dihydropyridinecalcium channel blockers (DH CCBs) are commonly used for hypertension in older adults. However, loop diuretics can be inappropriately added to treat DH CCB-induced edema, putting individuals at increased risk for adverse events and potential decreases in quality of life. METHODS: We conducted a cross-sectional analysis using United States Medical Expenditure Panel Survey (MEPS) data from 2003 to 2015. Adults aged ≥ 55 years without congestive heart failure, nephrotic syndrome, chronic kidney disease, renal failure, and cirrhosis who had consecutive rounds of DH CCB use (round 1 and 2 or round 3 and 4) and completed the self-administered questionnaire (SAQ) were included. Patients initiated on loop diuretics in round 2 or 4 were compared to those not initiated. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were analyzed using multivariable linear regression models. RESULTS: Among 5,458,467 DH CCB users (weighted), 3.4% of individuals were identified with new loop diuretic use (185,130 weighted). After adjusting for covariates, DH CCB plus loop diuretic use was associated with a PCS score 3.12 units lower (95% confidence interval - 5.40 to - 0.83; p = 0.008) than DH CCB use alone. We observed no significant difference in MCS score (p = 0.160) among DH CCB plus loop diuretic users compared to DH CCB users alone. CONCLUSIONS: New loop diuretic use was associated with lower physical functioning among DH CCB users. These findings suggest that this potential prescribing cascade may result in both significant and clinically meaningful decreases in health-related quality of life. It is important for clinicians to avoid or intervene on this inappropriate prescribing cascade when possible.
Authors: Ann S Doherty; Faiza Shahid; Frank Moriarty; Fiona Boland; Barbara Clyne; Tobias Dreischulte; Tom Fahey; Seán P Kennelly; Emma Wallace Journal: Pharmacol Res Perspect Date: 2022-10