Longitudinal Impact of Antihypertensive Polypharmacy on Geriatric Syndromes

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

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Abstract

DESCRIPTION (provided by applicant): Multiple drug use or polypharmacy due to medications from different classes that share similar pharmacological side effects is of concern in older adults. Antihypertensive polypharmacy is a common and important example of this phenomenon. Antihypertensive polypharmacy may contribute to the development of geriatric syndromes. Geriatric syndromes such as cognitive impairment, urinary incontinence and mobility problems/falls are also common, morbid and costly for older adults. With the trend towards increased use of medications, information is needed regarding the impact of antihypertensive polypharmacy on geriatric syndromes in older adults. The long term objective of the proposed research is to enhance the health of the elderly by determining the magnitude of the risk of antihypertensive polypharmacy on geriatric syndromes so that prescribing guidelines can be developed, health outcomes improved and health care costs reduced. Using a longitudinal design, the immediate objective is to determine the time-varying impact of antihypertensive polypharmacy on geriatric syndromes in multiple intervals up to 5 years. Antihypertensive polypharmacy will be operationally defined as the use of 2 or more medications from any of seven medication classes: 1) beta blockers;2) alpha blockers;3) calcium channel blockers;4) angiotensin converting enzyme inhibitors;5) angiotensin receptor blockers;6) direct vasodilators;and 7) diuretics). We will also examine the impact of the combined standardized daily dosage and duration of use of these multiple antihypertensive medications. We will specifically determine the association between antihypertensive polypharmacy (and change in antihypertensive polypharmacy within each interval) and mobility problems/falls (as measured by self-reported mobility limitations, Established Populations for Epidemiologic Studies of the Elderly lower extremity battery, gait speed, and recurrent falls), cognitive function (as measured by the Modified Mini-Mental State Examination, and self-reported urinary incontinence (any and type). The specific hypotheses to be tested are that, compared with non affected elders, elderly participants with antihypertensive polypharmacy (as defined by two alternative approaches) that is present or increasing in a time interval will have greater mobility limitations, increased recurrent falls, increased cognitive decline, and increased likelihood of urinary incontinence, after controlling for important covariates (e.g., measured blood pressure). This study capitalizes on data from the NIA funded longitudinal Health, Aging and Body Composition Study. Studies of the effects of polypharmacy on health, disease, and disability in older persons are a priority research area for the NIA Geriatrics and Clinical Gerontology Program.