CHARACTERIZATION OF HYPERTENSION IN A INTERNAL MEDICINE WARD

Abstract

Introduction: Arterial hypertension is a serious disease, affecting more than 60% of individuals over 60 years-old. It is associated with the development of cardiac disease, terminal renal failure and cerebral disease, with increased risk of cognitive decline and dementia. The World Health Organization and the European Society of Cardiology forewarn about a low therapeutic compliance and impact, thus being controlled in just 14% of cases. They recommend starting with combined agents in a single pill to increase its compliance and efficacy, lowering adverse effects and minimizing the serious events associated with hypertension.
Objectives: Characterize the hypertensive patients in an internal medicine ward; evaluate the applicability of the Hypertension guidelines with combined therapy in the hypertensive patients admitted to an internal medicine ward; identify the main classes prescribed.
Methods: Hypertensive patients admitted in 12 beds in an internal medicine ward during 2021 were identified and characterized on their age, gender, target organ damage (ischemic cardiopathy records, cerebrovascular disease, chronic renal failure, atrial fibrilation, dementia) and antihypertensive class (angiotensin-converting enzyme (ACE) inhibitors [ACEi], angiotensin II receptor blockers [ARBs], calcium channel blockers [CCB], beta blockers or diuretic) at admission and discharge and it was recorded the combined single pill prescribed. Transferred or deceased patients were excluded.
Results: 130 patients were included, of which 53.1% (n=69) were male, with mean age of 82 years. Of these, 82.3% (n=107) had one or more target organ damaged, being heart failure (n=60, 46.2%) and cerebrovascular disease (n=49, 37.7%) the most commonly observed. At admission, 15 patients (11.5%) did not have antihypertensive drugs and 63.1% (n=82) used 2 or more antihypertensive agents. Combined therapy was identified in 42 patients (32.3%), mainly the combination of ARB and diuretic (n=19), ACEi and diuretic (n=8) or ACEi and CCB (n=7). At discharge it was shown that 13.1% (n=17) did not do antihypertensive treatment and 61.5% (n=80) used 2 or more antihypertensive agents. Combined therapy was prescribed in 17.7% (n=23) patients, more frequently ARB and diuretic, ACEi and diuretic and ACEi and CCB (n=13, n=5 e n= 4, respectively) the most commonly used. Only a patient was started on combined therapy (ACEi and CCB).
Conclusion: Contrary to the recommendations, a reduction in the prescription of combined therapy was observed, with suspension of antihypertensive agents in 13.1% of patients. The authors consider the lack of motives for the suspension of the agents as the main limitation to the study. In the elderly, compliance is directly conditioned by several risk factors, such as cognitive alterations, dependency status, multiple pathologies, polymedication, management of their secondary effects and medical interactions. Individualizing and simplifying therapies are essential tools to clinical practice.