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Pajewski NM, Supiano MA. We have the technology: Why aren't better blood pressure data available from nursing home residents? J Am Geriatr Soc 2023; 71:2046-2048. [PMID: 37114862 PMCID: PMC10524157 DOI: 10.1111/jgs.18389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/26/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
This editorial comments on the article by Liu et al. in this issue.
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Affiliation(s)
- Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Division of
Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem,
NC, USA
| | - Mark A. Supiano
- Division of Geriatrics, Department of Internal Medicine,
Spencer Fox Eccles School of Medicine at the University of Utah, and University of
Utah Center on Aging, Salt Lake City, Utah, USA
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Hung A, Wang J, Moriarty F, Manja V, Eshetie T, Tegegn HG, Anderson TS, Radomski TR, Steinman MA. Value assessment of deprescribing interventions: Suggestions for improvement. J Am Geriatr Soc 2023; 71:2023-2027. [PMID: 36808728 PMCID: PMC10258143 DOI: 10.1111/jgs.18298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, NY, United States
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Veena Manja
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Health Policy, Stanford University, CA, United States
| | - Tesfahun Eshetie
- Registry of Senior Australians. Healthy Ageing Research Consortium. South Australian Health and Medical Research Institute, Adelaide SA, Australia
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide SA, Australia
| | | | - Timothy S. Anderson
- Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Thomas R. Radomski
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Michael A. Steinman
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
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Trimarco V, Manzi MV, Izzo R, Mone P, Lembo M, Pacella D, Esposito G, Falco A, Morisco C, Gallo P, Santulli G, Trimarco B. The therapeutic concordance approach reduces adverse drug reactions in patients with resistant hypertension. Front Cardiovasc Med 2023; 10:1137706. [PMID: 37215551 PMCID: PMC10196370 DOI: 10.3389/fcvm.2023.1137706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Adverse drug reactions (ADRs) remain among the leading causes of therapy-resistant hypertension (TRH) and uncontrolled blood pressure (BP). We have recently reported beneficial results in BP control in patients with TRH adopting an innovative approach, defined as therapeutic concordance, in which trained physicians and pharmacists reach a concordance with patients to make them more involved in the therapeutic decision-making process. Methods The main scope of this study was to investigate whether the therapeutic concordance approach could lead to a reduction in ADR occurrence in TRH patients. The study was performed in a large population of hypertensive subjects of the Campania Salute Network in Italy (ClinicalTrials.gov Identifier: NCT02211365). Results We enrolled 4,943 patients who were firstly followed-up for 77.64 ± 34.44 months, allowing us to identify 564 subjects with TRH. Then, 282 of these patients agreed to participate in an investigation to test the impact of the therapeutic concordance approach on ADRs. At the end of this investigation, which had a follow-up of 91.91 ± 54.7 months, 213 patients (75.5%) remained uncontrolled while 69 patients (24.5%, p < 0.0001) reached an optimal BP control. Strikingly, during the first follow-up, patients had complained of a total of 194 ADRs, with an occurrence rate of 68.1% and the therapeutic concordance approach significantly reduced ADRs to 72 (25.5%). Conclusion Our findings indicate that the therapeutic concordance approach significantly reduces ADRs in TRH patients.
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Affiliation(s)
- Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, “Federico II” University, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Pasquale Mone
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, “Federico II” University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Angela Falco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, “Federico II” University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
| | - Paola Gallo
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
- Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Aging Research, Einstein Institute for Neuroimmunology and Inflammation (INI), Albert Einstein College of Medicine, New York, NY, USA
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences,“Federico II” University, Naples, Italy
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
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Sheppard JP, Benetos A, McManus RJ. Antihypertensive Deprescribing in Older Adults: a Practical Guide. Curr Hypertens Rep 2022; 24:571-580. [PMID: 35881225 PMCID: PMC9568439 DOI: 10.1007/s11906-022-01215-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To summarise evidence on both appropriate and inappropriate antihypertensive drug withdrawal. RECENT FINDINGS Deprescribing should be attempted in the following steps: (1) identify patients with several comorbidities and significant functional decline, i.e. people at higher risk for negative outcomes related to polypharmacy and lower blood pressure; (2) check blood pressure; (3) identify candidate drugs for deprescribing; (4) withdraw medications at 4-week intervals; (5) monitor blood pressure and check for adverse events. Although evidence is accumulating regarding short-term outcomes of antihypertensive deprescribing, long-term effects remain unclear. The limited evidence for antihypertensive deprescribing means that it should not be routinely attempted, unless in response to specific adverse events or following discussions between physicians and patients about the uncertain benefits and harms of the treatment. PERSPECTIVES Clinical controlled trials are needed to examine the long-term effects of deprescribing in older subjects, especially in those with comorbidities, and significant functional decline.
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Affiliation(s)
- James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
| | - Athanase Benetos
- Maladies du Vieillissement, Gérontologie Et Soins Palliatifs", and Inserm DCAC u1116, CHRU-Nancy, Université de Lorraine, 54000, PôleNancy, France
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
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Romigi A. Deprescribing antihypertensive drugs after starting OSA primary therapy: “first do no net harm?”. Sleep 2022; 45:6634036. [DOI: 10.1093/sleep/zsac138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Romigi
- Sleep Medicine Center IRCCS Neuromed , Pozzilli (IS) , Italy
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