Abstract 512: Drugs in the Elderly: Threats and Opportunities

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Martin Wehling
Keyword(s):  
Elderly People ◽  
Antihypertensive Drugs ◽  
Rank Order ◽  
Renin Angiotensin System ◽  
The Elderly ◽  
The United States ◽  
Channel Blockers ◽  
Aged Population ◽  
Type D ◽  
Long Acting

Taking 10 and more drugs is unpredictable and may cause more harm than good, given that up to 100,000 medication-related deaths in the United States annually. An early attempt to improve drug safety in the aged population was the establishment of criteria for drugs to avoid by Beers in 1997. The evidence for the effectiveness of the Beers list is not compelling.. There should also be a positive labelling of drugs that are indispensable in elderly people as data on morbidity, mortality, and safety are available or emerging for this particular group. There is increasing clinical evidence for beneficial action of, for example, antihypertensive drugs (e.g., Hypertension in the Very Elderly Trial) in elderly people. Drugs should be labelled taking into consideration their usefulness for elderly people (Table 1) This classification would be an extension of the Beers approach into the positive listing of valuable drugs. This seems necessary as overtreatment and undertreatment are both typical problems of the aged population. Undertreatment, for example, relates to the poor control of arterial hypertension elderly people and may leave more than half of the patients un- or undertreated. The FORTA classification for antihypertensive drugs as an example is as follows: diuretics B, betablockers B, renin-angiotensin-system blockers A, long acting dihydropyridine calcium channel blockers (CCB) A, CCBs, verapamil type D, spironolactone C, alphablockers C, clonidine D, minoxidil D. The typical use of the scheme would address general practitioners struggling with polypharmacy. They would then synthesize the recommendations into a rank order of drugs that they could use to cut the list short.

Hypertension

2019 ◽  
pp. 3-32
Author(s):  
Robert Zweiker ◽  
Sabine Perl
Keyword(s):  
Health Care Providers ◽  
Antihypertensive Drugs ◽  
Renin Angiotensin System ◽  
The Elderly ◽  
Pharmacological Therapy ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
Choice Of Treatment ◽  
Risk Treatment ◽  
Hereditary Nature

Hypertension has a major impact on cardiovascular and overall morbidity and mortality of patients. In most cases, the condition is caused by polygenetic predisposition and environmental lifestyle factors. General practitioners and other health-care providers should seek to screen for high blood pressure (BP) in all adults. Public knowledge about the disease can also help to detect previously unknown hypertension. First-degree family members of hypertensive patients deserve special attention because of the hereditary nature of the disease. Most measurements are made as in-office BP readings (>140/>90mmHg), which should be confirmed by out-of-office BP measurements in order to uncover white-coat effects. The basis for treatment decisions is ideally a calculation of the overall cardiovascular risk. Treatment of hypertension consists of both non-pharmacological lifestyle changes and pharmacological therapy. Several classes of antihypertensive drugs are available. The choice of medication is mainly dependent on compelling indications, as their main effect is BP lowering per se. From a hypertensiologist’s view, renin–angiotensin system inhibition seems an appropriate first choice of treatment for younger patients, whereas the elderly benefit more from calcium channel blockers and diuretics. Nevertheless, therapy based on the combination of 2–3 drugs is preferable in most cases.

scholarly journals Accelerated repurposing and drug development of pulmonary hypertension therapies for COVID-19 treatment using an AI-integrated biosimulation platform

2020 ◽  
Author(s):  
Kaushik Chakravarty ◽  
Victor Antontsev ◽  
Aditya Jagarapu ◽  
Yogesh Bundey ◽  
Hypatia Hou ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Renin Angiotensin System ◽  
The United States ◽  
Mechanistic Modeling ◽  
World Health ◽  
Channel Blockers ◽  
Health Organization ◽  
Line Of Therapy

Abstract A World Health Organization-declared pandemic, COVID-19, has affected more than 4 million people worldwide with over 100,000 deaths and growing in the United States. Due to the fast-spreading and multi-targeted nature of the virus, it is clear that drugs and/or vaccines need to be developed at an accelerated rate, and a combinatorial approach may stand to be more successful than a single drug therapy. Among several targets and pathways that are under investigation, the renin-angiotensin system (RAS) and specifically Angiotensin converting enzyme (ACE), and Ca2+ -mediated SARS-CoV-2 cellular entry and replication are noteworthy. A combination of ACE inhibitors (e.g. benazepril) and calcium channel blockers (CCB, e.g. amlodipine), a critical line of therapy for pulmonary hypertension, has shown therapeutic relevance in COVID-19 when investigated independently. To that end, we conducted in silico modeling using BIOiSIM, an AI-integrated mechanistic modeling platform by utilizing known preclinical in vitro and in vivo datasets to accurately simulate systemic therapy disposition and site-of-action penetration of the CCB and ACEI compounds to tissues implicated in COVID-19 pathogenesis.

Trends and pattern of the utilization of cardiovascular medicines in Lithuania in 2003–2012

2014 ◽  
Vol 21 (3) ◽  
pp. 143-150
Author(s):  
Ingrida Lisauskienė ◽  
Kristina Garuolienė ◽  
Jolanta Gulbinovič
Keyword(s):  
Antihypertensive Drugs ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Insurance Fund ◽  
Channel Blockers ◽  
Prescribing Pattern ◽  
Converting Enzyme Inhibitors ◽  
Mortality And Morbidity ◽  
High Consumption ◽  
Lipid Modifying Agents

Background. Despite the wide use of cardiovascular (CV) drugs, CV diseases are still the leading cause of mortality and morbidity. Analysis of drug utilization gives a possibility to evaluate effectiveness of interventions. Materials and methods. The aim of the study was to evaluate CV medicines consumption in Lithuania in 2003–2012. Data was retrieved from the SVEIDRA database of the National Health Insurance Fund. Utilization of the following groups of CVM (ATC group C) was analyzed: C02 – antihypertensive drugs, C03 – diuretics, C07 – beta blocking agents (BBs), C08 – calcium channel blockers (CCBs), C09 – agents acting on the renin–angiotensin system, C10 – lipid modifying agents. ATC/DDD methodology was used. Data was expressed as a number of DDD per 1  000 inhabitants per day (DDD/TID). Results. Consumption of CVM went from 134.5 DDD/TID in 2003 to 352.2 in 2012. Angiotensin converting enzyme inhibitors (ACEI) were the most consumed ones (66–114.8 DDD/TID), followed by CCBs (19.4–38.8 DDD/TID) and BBs (12.5–52.6 DDD/TID).There was high consumption of antihypertensives (4.7–23.9 DDD) and low consumption of diuretics (9.4–16.9 DDD/TID) and lipid modyfing agents (0.4–7.4 DDD/TID). Increasing utilization was noticed in the angiotensin II antagonist (ARBs) group (42 DDD/TID), ACEI combinations (38.6 DDD/TID) and ARBs combinations (12.9 DDD/TID) in 2012. Conclusions. Utilization of CV medicines increased in Lithuania in 2003–2012. ACEI held the first position. An extremely low utilization of lipid modifying agents, diuretics and high consumption of alpha-receptor blockers showed the need of actions on changing the prescribing pattern of CV drugs.

scholarly journals Rates of delirium associated with calcium channel blockers compared to diuretics, renin-angiotensin system agents and beta-blockers: An electronic health records network study

2020 ◽  
Vol 34 (8) ◽  
pp. 848-855 ◽  
Author(s):  
Paul J Harrison ◽  
Sierra Luciano ◽  
Lucy Colbourne
Keyword(s):  
Calcium Channel ◽  
Antihypertensive Drug ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Renin Angiotensin System ◽  
Negative Control ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Renin Angiotensin

Background: Antihypertensive drugs, especially calcium channel blockers, have been associated with differential rates of a number of neuropsychiatric outcomes. Delirium is commonly attributed to medication, including antihypertensive drugs, but delirium incidence has not been compared directly between antihypertensive drug classes. Methods: Using a federated electronic health records network of 25.5 million people aged 50 years or older, we measured rates of delirium over a two-year period in patients prescribed calcium channel blockers compared to the other main antihypertensive drug classes. Extensive propensity score matching was used to create cohorts matched for a range of demographic factors and delirium risk factors. Negative control outcomes were also measured. Results: Cohort sizes ranged from 54,000–577,000. Delirium was more common with calcium channel blockers than with renin-angiotensin system agents (~40% higher) but less common than with beta-blockers (~20% lower). These differences remained when patients with a range of other delirium risk factors were excluded, and they were not paralleled by the negative control outcomes. Comparisons between calcium channel blockers and diuretics produced inconclusive results. Conclusions: Calcium channel blockers are associated with higher rates of delirium than renin-angiotensin system agents, but lower rates compared to beta-blockers. The findings add to the list of factors which may be considered when choosing antihypertensive drug class.

scholarly journals Coronavirus Highly Hits the Elderly People and the Natality Rate: A SocioDemographic Appraisal

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
United States ◽  
Elderly People ◽  
The Elderly ◽  
The United States ◽  
Easy Access ◽  
Medical Treatments ◽  
Social Actors ◽  
The Social ◽  
The World ◽  
Natality Rate

The unexpected Corona crisis is affecting all ages, but mostly the elderly people of 65 years and over have been infected, hit and dead. The Coronavirus has also highly affected the rate of natality everywhere in the world. Besides that, many marriages have been postponed or suspended. In the United States where the number of Coronavirus affected people is the highest as compared with other parts of the world; 8 out of 10 deaths reported have been in adults 65 years and older [1]. Therefore, the present crisis will lead to the lack of children, optimistically when Coronavirus will be behind us. Even the children during the Corona crisis have not easy access to pediatrics and medical treatments. So, the natality situation is currently a hidden event, not being monitored by the social actors. The aging affected people are observed and talked about, whereas the newborns are not spoken about. Increasing number of developing societies are concerned with the issue. Therefore, natality issue needs more investigation by the sociologists as well as demographers. The method of research used in the present research is of qualitative type, and the whole theme is more sociologically appraised.

scholarly journals ДОСЛІДЖЕННЯ АСОРТИМЕНТУ АНТИГІПЕРТЕНЗИВНИХ ПРЕПАРАТІВ, ЩО ПРЕДСТАВЛЕНІ НА ФАРМАЦЕВТИЧНИХ РИНКАХ УКРАЇНИ ТА ПОЛЬЩІ

2015 ◽  
Author(s):  
Н. Ю. Полуйчак ◽  
М. Б. Демчук ◽  
О. О. Юр'єва ◽  
Т. А. Грошовий
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Renin Angiotensin System ◽  
Pharmaceutical Market ◽  
Channel Blockers ◽  
Angiotensin System ◽  
Pharmaceutical Markets ◽  
State Register

<h2>RESEARCH OF ANTIHYPERTENSIVE MEDICINESʼ ASSORTMENT WHICH ARE PRESENTED IN PHARMACEUTICAL MARKETS OFUKRAINEANDPOLAND</h2><h2>N.Yu. Poluychak, M.B. Demchuk, O.О. Yurуeva<sup>1</sup>, T.A. Groshovyi,</h2><h2>SHEI «TernopilStateMedicalUniversityby I.Ya. Horbachevsky»</h2><h2><sup>1</sup>JSC «Farmak»</h2><h2>Summary. The article analyzes the antihypertensive medicinesʼ assortment which is presented in the pharmaceutical markets ofUkraineandPoland. Assortment policies of pharmaceutical manufacturers of antihypertensive drugs, diuretics, b-adrenergic blockers, calcium antagonists, drugs that affect the renin-angiotensin system are analyzed.</h2><h2>Key words: hypertension, pharmaceutical market ofUkraine, pharmaceutical market ofPoland, antihypertensive medicines.</h2><p> </p><p><strong>Introduction. </strong>Diseases of the cardiovascular system (CAS) are the leader in the structure of morbidity and mortality in the adult population of highly developed countries. Among pathology of CAS the most common is arterial hypertension (AH), which is found in 15-20% of adults in industrialized countries and is recognized as a chronic no communicable disease. Despite the global nature of the prevalence of hypertension, certain regions of the world differ greatly on this indicator. AG has acquired a large spread in the European Region.</p><p>         All classes of antihypertensive agents recommended by the European Society of Cardiology and the Society for AH (2003), US Joint National Committee (7th revision, 2003) and Ukrainian Society of Cardiology (2004) as first-line drugs in the treatment of hypertension, almost equally reduce blood pressure. It is well known that such pharmacological groups that can be used as part of a monotherapy and in combination therapy include the following drugs: diuretics; angiotensin-converting enzyme (ACE) inhibitors; calcium channel blockers; angiotensin II receptor antagonists; β-blockers. The group of second-line drugs is forming alpha 1-blockers; Rauvolfia alkaloids; central α2-agonists; imidazoline receptor agonist drugs.</p><p>         The purpose of this study is to<strong> </strong>study the assortment medicines for the treatment of hypertension, which are available to consumers onUkraine by comparison with an assortment of antihypertensive drugs, which are represented in the pharmaceutical market inPoland.</p><p>         <strong>Methods.</strong> Analysis of the assortment of drugs that are presented in the domestic pharmaceutical market conducted under Ukrainian State Register of medicines. For the study of current state of the Polish market of antihypertensive agents, the Polish State Register of medicines and official website http://pharmindex.pl, http://leki-informacje.pl., is applied.</p><p>         <strong>Results and discussion</strong>. According to the State Register of medicines ofUkraine by January2015, a group of antihypertensive drugs consists of more than 790 drugs. The antihypertensive agentsʼ group represented more than 940 drugs on the Polish pharmaceutical market. According to ATC - classification analyzed following groups: C02 - antihypertensive drugs, C03 - diuretics, C07 - beta blocking agents, C08 - calcium channel blockers, C09 - agents acting on the renin-angiotensin system.</p><p><strong>Conclusions. </strong>The majority of medicines, which are offered on the European markets, are represented in domestic market. The exclusions are the medicines, which contain clopamide, chlortalidone, canreon – from the diuretics group, pindolol and acetebulol – from the β-blockers group, isradipine – from the group of calcium channel blockers, benazepril, cilazapril, trandolapril and imidapril – from angiotensin-converting-enzyme inhibitors group. Assortment of antihypertensive medicines in the market of Poland is represented by combined medicines of benazepril with diuretics, cilazapril with diuretics, ramipril with felodipine, aliskiren with amlodipine, which are absent on the domestic market.</p>

scholarly journals Consumption of single products versus fixed-dose combination medicines for hypertension and hyperlipidemia during 2015–2019 in South Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0259467
Author(s):  
Yujin Lee ◽  
Jihye Shin ◽  
Yujeong Kim ◽  
Dong-Sook Kim
Keyword(s):  
Older Adults ◽  
South Korea ◽  
Antihypertensive Drugs ◽  
Renin Angiotensin System ◽  
Fixed Dose ◽  
Channel Blockers ◽  
Defined Daily Dose ◽  
Annual Growth Rate ◽  
Angiotensin Ii Receptor ◽  
Reductase Inhibitors

Background Fixed-dose combinations can simplify prescribing, and numerous combination products exist for hypertension and dyslipidemia in South Korea. This study’s aim was to compare trends in the consumption of single products versus fixed-dose combinations for hypertension and hyperlipidemia. Methods and findings We analyzed the Korean national health insurance claims database from January 2015 through December 2019. Consumption of medicines was calculated using the defined daily dose per 1,000 inhabitants per day (DIDs) and expenditures over time. During 2015–2019, the use of antihypertensive drugs increased with an annual growth rate (AGR) of 0.9% for single products and with an AGR of 35.6% for fixed-dose combinations. A notable increase was observed for antihyperlipidemic combination drugs with an AGR of 268.1% compared to single products with 35.7%. For older adults (65+ years), the consumption of drugs for hypertension and hyperlipidemia was 3–4.5 and about 3 times higher, respectively, than in adults aged 20–64 years, and a sharp increase was found in antihyperlipidemic fixed-dose combinations among older adults. A large increase was seen for C09 (agents acting on the renin-angiotensin system) with an AGR of 36.5%, especially C09DB (angiotensin II receptor blockers + calcium channel blockers) was widely used and steeply increased with 114.2%. For antihyperlipidemic drugs, C10AA (HMG CoA reductase inhibitors) accounted for a large share and sharply increased, with 52.1 DIDs in 2019 and with an AGR of 78.4%, whereas C10BA (combinations of various lipid modifying agents) increased 9.6 times from 2.9 DIDs (96 million USD) in 2015 to 27.7 DIDs (912 million USD) in 2019. Conclusion The findings of increased consumption and drug spending among older adults underscores the need for real-world evidence about health outcomes of fixed-dose combinations in this population.

scholarly journals Accelerated repurposing and drug development of pulmonary hypertension therapies for COVID-19 treatment using an AI-integrated biosimulation platform

2020 ◽  
Author(s):  
Kaushik Chakravarty ◽  
Victor Antontsev ◽  
Aditya Jagarapu ◽  
Yogesh Bundey ◽  
Hypatia Hou ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Renin Angiotensin System ◽  
The United States ◽  
Mechanistic Modeling ◽  
World Health ◽  
Channel Blockers ◽  
Health Organization ◽  
Line Of Therapy

Abstract A World Health Organization-declared pandemic, COVID-19, has affected more than 4 million people worldwide with over 100,000 deaths and growing in the United States. Due to the fast-spreading and multi-targeted nature of the virus, it is clear that drugs and/or vaccines need to be developed at an accelerated rate, and a combinatorial approach may stand to be more successful than a single drug therapy. Among several targets and pathways that are under investigation, the renin-angiotensin system (RAS) and specifically Angiotensin converting enzyme (ACE), and Ca2+ -mediated SARS-CoV-2 cellular entry and replication are noteworthy. A combination of ACE inhibitors (e.g. benazepril) and calcium channel blockers (CCB, e.g. amlodipine), a critical line of therapy for pulmonary hypertension, has shown therapeutic relevance in COVID-19 when investigated independently. To that end, we conducted in silico modeling using BIOiSIM, an AI-integrated mechanistic modeling platform by utilizing known preclinical in vitro and in vivo datasets to accurately simulate systemic therapy disposition and site-of-action penetration of the CCB and ACEI compounds to tissues implicated in COVID-19 pathogenesis.

Visit-to-visit Blood Pressure Variability and Arterial Stiffness: Which Came First: The Chicken or the Egg?

2019 ◽  
Vol 25 (6) ◽  
pp. 685-692 ◽  
Author(s):  
Shunsuke Miyauchi ◽  
Michiaki Nagai ◽  
Keigo Dote ◽  
Masaya Kato ◽  
Noboru Oda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Antihypertensive Agents ◽  
The Elderly ◽  
Channel Blockers ◽  
Arterial Remodeling ◽  
Significant Independent Risk Factor ◽  
Aortic Artery ◽  
Long Acting ◽  
The Relationship

Earlier studies have shown that visit-to-visit blood pressure (BP) variability (VVV) served as a significant independent risk factor of stroke, specifically, in the high-risk elderly of cardiovascular disease (CVD). Although the mechanism is not clearly understood, arterial remodeling such as carotid artery, coronary artery and large aortic artery would be a strong moderator in the relationship between VVV and CVD incidence. Recent studies have provided evidence that VVV predicted the progression of arterial stiffness. While the class of antihypertensive agents is suggested to be an important determinant of VVV, long-acting calcium channel blockers use (CCBs) is associated with the reduction of VVV, and thus, is suggested to decrease the arterial stiffness. Specifically, the relationship between VVV and coronary arterial remodeling has never been reviewed until now. This article summarizes the recent literature on these topics. In the elderly hypertensives, strict BP control using CCBs could play a pivotal role in suppressing arterial stiffening via VVV reduction.

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