Polypharmacy Pitfalls in Heart Failure and Hypertension

The prevalence of hypertension increases with age, so much so that patients 65 and older frequently receive this diagnosis. Many older adults with hypertension also have 2 or more chronic comorbidities, including heart failure and stroke.

Because of this, the typical 65-year-old patient takes 5 medications, a number that jumps to 7 by age 85. Pitfalls of this polypharmacy include increased risk of adverse drug events (ADEs), drug-drug interactions, and medication nonadherence.

Recently, researchers from the Tulane University School of Medicine identified factors that contribute to medication mismanagement in elderly patients with hypertension. These researchers offered strategies to reduce polypharmacy’s impact in a review article published in the Journal of Clinical Hypertension.

Pharmacists’ advanced knowledge of prescription and OTC medications, herbal supplements, and drug-drug interactions is a proven advantage to medical teams, and they effectively reduce polypharmacy.

Nonsteroidal anti-inflammatory drugs (NSAIDs), which are used in prescription-strength medications by 20% to 30% of older adults in developed countries and countless others in OTCs, increase sodium and water retention. As a result, NSAID use increases the risk of initiating antihypertensive medication by 1.5 to 1.8 times.

Acetaminophen has been the preferred analgesic for patients with high cardiovascular risk and hypertension. Regardless, acetaminophen use may also increase blood pressure (BP) through an unknown mechanism. Larger, long-term studies are needed to confirm this theory.

Glucocorticoids, recombinant erythropoietin, ergotamine, cimetidine, and grapefruit juice may interfere with BP. Because of this, the review authors cautioned prescribers to limit the use of these products in older patients with hypertension.

Both the European Society of Cardiology and the European Society of Hypertension support the use of fixed-dose combination antihypertensives for improving long-term medication adherence and reducing pill burden. In fact, a meta-analysis of 40,000 subjects demonstrated that fixed-dose combination antihypertensives lower all-cause health care costs and improve adherence compared with administrating individual formulations.

Other strategies for evaluating and improving patient adherence include ingestible sensor systems (disposable Bluetooth technology that sends data to a smartphone), medical audits, and electronic reminder systems such as phone alarms.