Hypertension (especially isolated systolic) is the most common chronic condition in older adults and is a major risk factor for both cardiovascular and cerebrovascular diseases. Previous randomized controlled studies have shown that blood pressure treatment in older adults (65+) can be effective and reduce hypertension-related complications. However there is uncertainty regarding the generalizability of these beneficial findings to frail community dwelling older adults 85+ years of age and the potential risks that the sometimes necessary use of multiple anti-hypertensives (i.e., polypharmacy) to control blood pressure may have. Indeed, the use of multiple anti-hypertensives in older adults has been linked to increased risk of mobility problems and cognitive impairment. The long term objective of the proposed research is to enhance the health of the elderly by determining the magnitude of the benefits and risks of antihypertensive use so that future prescribing guidelines can be more evidence based and less dependent on expert opinion. Using a longitudinal design, the immediate objective is to determine the potential benefits and risks of antihypertensive use in community dwelling older adults with hypertension over a five year follow up. Anti-hypertensives will be operationally defined as medications from the following eight classes: 1) beta blockers;2) peripheral alpha blockers;3) calcium channel blockers;4) angiotensin converting enzyme inhibitors;5) angiotensin receptor blockers;6) direct vasodilators;7) diuretics and 8) central alpha blockers.
In AIM 1, we will examine potential benefits by determining the association between antihypertensive use (as defined by four alternative approaches above) and blood pressure control (defined as d 140/90 mmHg) and hypertension-related complications (i.e., adjudicated hospitalization or death due to cardiovascular and cerebrovascular diseases).
The Aim 1 specific hypotheses to be tested among those with hypertension are that, compared with non exposed elders, participants with antihypertensive use will be more likely to have blood pressure control and less likely to have hypertension-related complications after propensity score matching and adjusting for important covariates in multivariable analyses.
In Aim 2, we will examine potential risks by determining the association between antihypertensive use (as defined by four alternative approaches above) and mobility problems (Short Physical Performance Battery [SPPB], and gait speed), and cognitive function decline (as measured by the Modified Mini-Mental State Examination [3MS] and the CLOX 1 Test).
Aim 2 specific hypotheses to be tested among those with hypertension are that, compared with non exposed elders, participants with antihypertensive use (as defined by four alternative approaches detailed below) will have worse performance on the 3MS, CLOX1, the SPPB, and usual walking pace over six meters after propensity score matching and adjusting for important covariates (e.g., blood pressure) in multivariable analyses.

Public Health Relevance

The current proposal builds on our previous and successful NIA funded grants (R01 and R56) that examined CNS medications and specific self-reported geriatric syndromes using the rich and pre-existing NIA funded Health ABC study database. Funding of this proposal will allow us to extend our work to anti-hypertensives and examine important measured geriatric outcomes (i.e., functional status and cognition), physiologic measures (i.e., blood pressure control), and morbidity and mortality (i.e., hospitalization and death due to cardiovascular and cerebrovascular disease). Such studies are consistent with NIA's priority comparative effectiveness research area.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
2R01AG027017-04A1
Application #
8290634
Study Section
Special Emphasis Panel (ZRG1-PSE-K (04))
Program Officer
Salive, Marcel
Project Start
2006-09-30
Project End
2014-08-31
Budget Start
2012-09-30
Budget End
2014-08-31
Support Year
4
Fiscal Year
2012
Total Cost
$266,875
Indirect Cost
$91,875
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Lo-Ciganic, Wei-Hsuan; Perera, Subashan; Gray, Shelly L et al. (2015) Statin use and decline in gait speed in community-dwelling older adults. J Am Geriatr Soc 63:124-9
Aspinall, Sherrie L; Zhao, Xinhua; Semla, Todd P et al. (2015) Epidemiology of drug-disease interactions in older veteran nursing home residents. J Am Geriatr Soc 63:77-84
Handler, Steven M; Cheung, Pui Wen; Culley, Colleen M et al. (2014) Determining the incidence of drug-associated acute kidney injury in nursing home residents. J Am Med Dir Assoc 15:719-24
Hanlon, Joseph T; Semla, Todd P; Schmader, Kenneth E (2014) Medication misadventures in older adults: literature from 2013. J Am Geriatr Soc 62:1950-3
Marcum, Zachary A; Driessen, Julia; Thorpe, Carolyn T et al. (2014) Effect of multiple pharmacy use on medication adherence and drug-drug interactions in older adults with Medicare Part D. J Am Geriatr Soc 62:244-52
Maher, Robert L; Hanlon, Joseph; Hajjar, Emily R (2014) Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 13:57-65
Marcum, Zachary A; Hanlon, Joseph T; Strotmeyer, Elsa S et al. (2014) Gastroprotective agent underuse in high-risk older daily nonsteroidal anti-inflammatory drug users over time. J Am Geriatr Soc 62:1923-7
Lo-Ciganic, Wei-Hsuan; Boudreau, Robert M; Gray, Shelly L et al. (2013) Changes in cholesterol-lowering medications use over a decade in community-dwelling older adults. Ann Pharmacother 47:984-92
Romagnoli, Katrina M; Handler, Steven M; Hochheiser, Harry (2013) Home care: more than just a visiting nurse. BMJ Qual Saf 22:972-4
Hanlon, Joseph T; Boudreau, Robert M; Perera, Subashan et al. (2013) Racial differences in antilipemic use and lipid control in high-risk older adults: post-Medicare Part D. Am Heart J 166:792-7

Showing the most recent 10 out of 55 publications