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Prescribing cascades in hypertension treatment with CCB (calcium channel blockers) (June 2020)

Prescribing cascades in hypertension treatment with CCB (calcium channel blockers) (June 2020)


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Prescribing cascades in hypertension treatment with CCB (calcium channel blockers) (June 2020)


To prescribe a cascade may occur when an untoward drug side effect is misinterpreted as a new medical sign and treated with a potentially unnecessary drug. In a retrospective cohort report of more than 40,000 elderly adults with HT, 1.4 % of ptns prescribed a calcium channel blocker were subsequently prescribed a loop diuretic agent within 90 d. compared with 0.7 % of ptns prescribed a different anti-HT. Since the peripheral edema from CCB (calcium channel blockers) is due to fluid redistribution rather than fluid overload, ttt with a diuretic is NOT currently indicated and cn lead to adverse sequelae, for example, AKI (acute kidney injury), electrolyte imbalance, drop out, and urine incontinence, particularly in older ptns.  

Savage RD, Visentin JD, Bronskill SE, et al. Evaluation of a Common Prescribing Cascade of Calcium Channel Blockers and Diuretics in Older Adults With Hypertension. JAMA Intern Med 2020; 180:643.

HYPERTENSION: Antihypertensive medication dose reduction in older adults (July 2020)


Despite the reported fact that most ptns with hypertension (HT) should be maintained on lifelong antihypertensive drug therapy, some ptns, particularly elderly adults, may be candidates for drug dose reduction. In a 12-wk randomized trial involving more than 600 adults aged ≥80 ys with systolic blood pressures <150 on multiple anti-HT, those exposed to medication dose reduction had similar rates of blood pressure optimization as those assigned to usual care. However, a third of those in the intervention g. needed to hv an anti-HT reinstated. Although this trial was of short period and longer term studies are needed, it supports drug dose reduction in some ptns with HT, which may be an opportunity for deep discussion and sharing decision making between the treating physician and his patient.   

Sheppard JP, Burt J, Lown M, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. JAMA 2020; 323:2039.