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Magvanjav O, Cooper-Dehoff RM, McDonough CW, Gong Y, Hogan WR, Johnson JA. Combination Antihypertensive Therapy Prescribing and Blood Pressure Control in a Real-World Setting. Am J Hypertens 2020; 33:316-324. [PMID: 31853537 DOI: 10.1093/ajh/hpz196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Specific combinations of two drug classes are recommended in a variety of clinical situations in the management of hypertension. These preferred combinations are based on complimentary blood pressure (BP) lowering mechanisms or benefit for a concomitant disease. METHODS Using electronic health records (EHRs) data from 27,579 ambulatory hypertensive patients, we investigated antihypertensive therapy prescribing patterns and associations of preferred two drug classes with BP control. RESULTS Overall, BP control, defined as BP <140/90 mm Hg, was 65% among treated patients. Preferred dual antihypertensive therapy was prescribed in 55% of patients with uncomplicated hypertension, 49% of patients with diabetes, and 47% of patients with a history of myocardial infarction (MI); these prescribing frequencies of preferred combinations were not explained by worse BP control on those combinations. In fact, we found suggestive evidence of association between prescribing of preferred two drug classes and improved BP control among post-MI (OR: 1.21, 95% CI: 0.99-1.48, P = 0.061) and uncomplicated hypertensive (OR: 1.11, 95% CI: 0.98-1.26, P = 0.089) patients. CONCLUSIONS Prescribing of guideline-recommended antihypertensive drug classes for concomitant diseases is suboptimal and prescribing of preferred/optimized drug class combinations was moderate. We did not find a clear association between the use of optimized drug class combinations and greater BP control. Overall, using EHR data, we identified potential opportunities for re-examining prescribing practices with implications for clinical decision support and healthcare improvement at the community and health system-wide levels.
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Affiliation(s)
- Oyunbileg Magvanjav
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rhonda M Cooper-Dehoff
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Kocyigit SE, Soysal P, Ates Bulut E, Dokuzlar O, Isik AT. Thiazide therapy is not related to any changes in cognitive function in older hypertensive patients with or without dementia: a 26-week follow-up study. Psychogeriatrics 2019; 19:16-22. [PMID: 30058745 DOI: 10.1111/psyg.12353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/11/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022]
Abstract
AIM The study aimed to evaluate the effect of thiazide diuretics, a first-line antihypertensive therapy, on cognitive function in elderly hypertensive patients with or without cognitive impairment. METHODS This retrospective and observational study assessed 286 elderly patients with hypertension. Patients were divided based on thiazide diuretic usage and then into dementia and non-dementia groups. The comprehensive geriatric assessment was performed for all patients. All participants were re-evaluated after a 26-week period. RESULTS In total, 133 patients, including 62 with dementia, took thiazide. There were no significant differences between baseline and follow-up laboratory findings, comprehensive geriatric assessment parameters, including detailed neurocognitive assessment, or electrolytes in the thiazide group, the non-thiazide group, and the dementia group (P > 0.05). CONCLUSION Thiazide therapy does not show any effect on cognitive function in older hypertensive adults regardless of dementia status.
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Affiliation(s)
- Suleyman Emre Kocyigit
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozge Dokuzlar
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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3
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Johnson KW, Shameer K, Glicksberg BS, Readhead B, Sengupta PP, Björkegren JLM, Kovacic JC, Dudley JT. Enabling Precision Cardiology Through Multiscale Biology and Systems Medicine. ACTA ACUST UNITED AC 2017; 2:311-327. [PMID: 30062151 PMCID: PMC6034501 DOI: 10.1016/j.jacbts.2016.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/20/2022]
Abstract
The traditional paradigm of cardiovascular disease research derives insight from large-scale, broadly inclusive clinical studies of well-characterized pathologies. These insights are then put into practice according to standardized clinical guidelines. However, stagnation in the development of new cardiovascular therapies and variability in therapeutic response implies that this paradigm is insufficient for reducing the cardiovascular disease burden. In this state-of-the-art review, we examine 3 interconnected ideas we put forth as key concepts for enabling a transition to precision cardiology: 1) precision characterization of cardiovascular disease with machine learning methods; 2) the application of network models of disease to embrace disease complexity; and 3) using insights from the previous 2 ideas to enable pharmacology and polypharmacology systems for more precise drug-to-patient matching and patient-disease stratification. We conclude by exploring the challenges of applying a precision approach to cardiology, which arise from a deficit of the required resources and infrastructure, and emerging evidence for the clinical effectiveness of this nascent approach.
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Affiliation(s)
- Kipp W Johnson
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khader Shameer
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin S Glicksberg
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ben Readhead
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Partho P Sengupta
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johan L M Björkegren
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Biochemistry and Biophysics Vascular Biology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joel T Dudley
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, New York.,Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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4
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Muntner P, Abdalla M, Correa A, Griswold M, Hall JE, Jones DW, Mensah GA, Sims M, Shimbo D, Spruill TM, Tucker KL, Appel LJ. Hypertension in Blacks: Unanswered Questions and Future Directions for the JHS (Jackson Heart Study). Hypertension 2017; 69:761-769. [PMID: 28320850 PMCID: PMC5472537 DOI: 10.1161/hypertensionaha.117.09061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Paul Muntner
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.).
| | - Marwah Abdalla
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Adolfo Correa
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Michael Griswold
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - John E Hall
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Daniel W Jones
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - George A Mensah
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Mario Sims
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Daichi Shimbo
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Tanya M Spruill
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Katherine L Tucker
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Lawrence J Appel
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.); Department of Medicine, Columbia University Herbert and Florence Irving Medical Center, New York, NY (M.A., D.S.); Department of Medicine, Jackson Heart Study (A.C., D.W.J., M.S.), Department of Data Science (M.G.), and Department of Physiology and Biophysics, Mississippi Center for Obesity Research (J.E.H.), University of Mississippi Medical Center, Jackson; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); Department of Population Health, NYU School of Medicine, New York, NY (T.M.S.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell (K.L.T.); and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
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Schaffer AL, Pearson SA, Buckley NA. How does prescribing for antihypertensive products stack up against guideline recommendations? An Australian population-based study (2006-2014). Br J Clin Pharmacol 2016; 82:1134-45. [PMID: 27302475 DOI: 10.1111/bcp.13043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS We describe choice of first-line antihypertensive drug therapy and uptake of fixed-dose combinations (FDCs) in Australia, and investigate the impact of initiation on FDCs and other non-recommended first-line therapies on treatment discontinuation. METHOD This was a population-based retrospective cohort study using a random 10% sample of persons dispensed an Australian Pharmaceutical Benefits Scheme listed medicine from 1 July 2005 to 30 June 2014. The primary outcomes were adherence to Australian recommendations at initiation of antihypertensive therapy, discontinuation of initial therapy and discontinuation of any therapy in the first year after initiation. RESULTS In our sample of 55 937 persons initiating therapy, 42.0% did so outside Australian recommendations, including not initiating on recommended monotherapy (26.3%) and not initiating on the lowest recommended dose (30.6%). Only 1.7% of individuals who were dispensed an FDC established therapy on the free combination regimen (as recommended) prior to switching. After adjusting for covariates, persons initiating on non-recommended monotherapy (OR = 2.64, 95% CI 2.47-2.83) or FDCs of two or more antihypertensives (OR = 1.42, 95% CI 1.30-1.55), were more likely to discontinue all antihypertensive drug treatment in the first year compared to persons initiating on recommended monotherapy. CONCLUSION More than half of antihypertensive initiators conformed to Australian guidelines. Initiation on FDCs and other non-recommended treatments was associated with lower persistence on antihypertensive therapy in the first year. Long-term effectiveness and outcomes may be enhanced by initiating with low dose monotherapy.
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Affiliation(s)
- Andrea L Schaffer
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas A Buckley
- Blackburn Building (D06), University of Sydney, Sydney, NSW, 2006, Australia
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Shimbo D, Barrett Bowling C, Levitan EB, Deng L, Sim JJ, Huang L, Reynolds K, Muntner P. Short-Term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment With Antihypertensive Medication. Circ Cardiovasc Qual Outcomes 2016; 9:222-9. [PMID: 27166208 DOI: 10.1161/circoutcomes.115.002524] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls after antihypertensive medication initiation and intensification. METHODS AND RESULTS We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90 127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007, and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the previous year. Intensification was defined by the addition of a new antihypertensive class, and separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days after antihypertensive medication initiation (odds ratio, 1.36 [95% confidence interval, 1.19-1.55]), adding a new class (odds ratio, 1.16 [95% confidence interval, 1.10-1.23]), and titration [odds ratio, 1.13 [95% confidence interval, 1.08-1.18]). These associations were attenuated beyond 15 days. CONCLUSIONS Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults.
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Affiliation(s)
- Daichi Shimbo
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
| | - C Barrett Bowling
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Emily B Levitan
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Luqin Deng
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - John J Sim
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Lei Huang
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Kristi Reynolds
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Paul Muntner
- From the Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, GA (C.B.B.); Emory University, Atlanta, GA (C.B.B.); Department of Epidemiology (E.B.L.), Department of Epidemiology (L.D.), Department of Epidemiology (L.H.), and Department of Epidemiology (P.M.), University of Alabama at Birmingham; Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (J.J.S.); and Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
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Chang TI, Evans G, Cheung AK, Cushman WC, Diamond MJ, Dwyer JP, Huan Y, Kitzman D, Kostis JB, Oparil S, Rastogi A, Roumie CL, Sahay R, Stafford RS, Taylor AA, Wright JT, Chertow GM. Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial. Hypertension 2016; 67:550-5. [PMID: 26865200 PMCID: PMC4755350 DOI: 10.1161/hypertensionaha.115.06851] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/22/2015] [Indexed: 02/03/2023]
Abstract
Thiazides and thiazide-type diuretics are recommended as first-line agents for the treatment of hypertension, but contemporary information on their use in clinical practice is lacking. We examined patterns and correlates of thiazide prescription in a cross-sectional analysis of baseline data from participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). We examined baseline prescription of thiazides in 7582 participants receiving at least 1 antihypertensive medication by subgroup, and used log-binomial regression to calculate adjusted prevalence ratios for thiazide prescription (versus no thiazide). Forty-three percent of all participants were prescribed a thiazide at baseline, but among participants prescribed a single agent, the proportion was only 16%. The prevalence of thiazide prescription differed significantly by demographic factors, with younger participants, women, and blacks all having higher adjusted prevalence of thiazide prescription than other corresponding subgroups. Participants in the lowest category of kidney function (estimated glomerular filtration rate <30 mL/min per 1.73 m2) were half as likely to be prescribed a thiazide as participants with preserved kidney function. In conclusion, among persons with hypertension and heightened cardiovascular risk, we found that thiazide prescription varied significantly by demographics and kidney disease status, despite limited evidence about relative differences in effectiveness.
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Affiliation(s)
- Tara I Chang
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.).
| | - Gregory Evans
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Alfred K Cheung
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - William C Cushman
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Matthew J Diamond
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Jamie P Dwyer
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Yonghong Huan
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Dalane Kitzman
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - John B Kostis
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Suzanne Oparil
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Anjay Rastogi
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Christianne L Roumie
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Rukmani Sahay
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Randall S Stafford
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Addison A Taylor
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Jackson T Wright
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
| | - Glenn M Chertow
- From the Division of Nephrology (T.I.C., R.S., G.M.C.) and Stanford Prevention Research Center (R.S.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Biostatistical Sciences (G.E.) and Internal Medicine (D.K.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (A.K.C.); Medical Service, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Department of Medicine, The Medical College of Georgia, Georgia Regents University, Augusta (M.J.D.); Division of Nephrology and Hypertension, Department of Medicine (J.P.D.) and Department of General Internal Medicine and Public Health (C.L.R.), Vanderbilt University, Nashville, TN ; Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia (Y.H.); Departments of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Department of Medicine, University of California, Los Angeles (A.R.); VA Tennessee Valley Healthcare System Geriatrics Research and Education Clinical Center (GRECC), Nashville (C.L.R.); Medical Care Line, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.A.T.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (J.T.W.)
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Medici V, McClave SA, Miller KR. Common Medications Which Lead to Unintended Alterations in Weight Gain or Organ Lipotoxicity. Curr Gastroenterol Rep 2016; 18:2. [PMID: 26700070 DOI: 10.1007/s11894-015-0479-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obesity is one of the most common chronic conditions in the world. Its management is difficult, partly due to the multiple associated comorbidities including fatty liver, diabetes, hypertension, and hyperlipidemia. As a result, the choice of prescription medications in overweight and obese patients has important implications as some of them can actually worsen the fat accumulation and its associated metabolic complications. Several prescription medications are associated with weight gain with mechanisms that are often poorly understood and under-recognized. Even less data are available on the distribution of fat and lipotoxicity (the organ damage related to fat accumulation). The present review will discuss the drugs associated with weight gain, their mechanism of action, and the magnitude and timing of their effect.
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Affiliation(s)
- Valentina Medici
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of California Davis, 4150 V Street, Sacramento, CA, 95816, USA.
| | - Stephen A McClave
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY, 40202, USA.
| | - Keith R Miller
- Department of Surgery, University of Louisville, ACB 2nd Floor, 550 South Jackson Street, Louisville, KY, 40202, USA.
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Correction: Antihypertensive medication classes used among Medicare beneficiaries initiating treatment in 2007-2010. PLoS One 2015; 10:e0118763. [PMID: 25803698 PMCID: PMC4372592 DOI: 10.1371/journal.pone.0118763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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