The aim of this study was to describe antihypertensive pharmacological therapy used in the very old hypertensive patients admitted to the Internal Medicine Clinic and compare it between those with and those without chronic kidney disease (CKD).Design and method:
We included all hypertensive patients aged over 80 years with chronic kidney disease (eGFR< 60 ml/min, CKD-EPI) admitted to the Internal Medicine Clinic from January through December 2015. For each patient we recorded demographic and anthropometric data, echocardiography data, antihypertensive treatment and co-morbidities.Results:
There were no significant differences between the two groups. However, contrary to expectations, angiotensin-converting enzyme inhibitors (ACEI) were the most prescribed monotherapy in the very old hypertensive patient with CKD, while calcium channel blockers (CCB) and alpha2-agonists (AA) were equally the most prescribed monotherapy in the non-CKD patients. Combination therapy (ACEI+BB+CCB, noted ABC) was similarly recommended in both CKD and non-CKD patients. Diuretics were seldom recommended alone, and, interestingly, were often used in combination with other antihypertensives irrespective of CKD status. In this elderly population there were no patients on thiazide or thiazide-like monotherapy. Furosemide was also the most frequently used diuretic on top of triple antihypertensive therapy (ABC). For other results see table.Conclusions:
Interestingly, even in the presence of CKD, ACEI, and not CCB, are the most prescribed antihypertensive drugs in this population of elderly hypertensives. Even though loop diuretics are not recommended for long term control of hypertension, in this population, they were preferred to other diuretics even in the case of non-CKD patients, a clinical practice often employed which goes against current guideline recommendations.