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Rodrigues RC, Gomes GKA, Sodré BMC, Lima RF, Barros DSL, Figueiredo ACMG, Stefani CM, Silva DLMD. Lists of potentially inappropriate medications for older people in primary care: a systematic review of health outcomes. CAD SAUDE PUBLICA 2024; 40:e00016423. [PMID: 38775606 PMCID: PMC11111166 DOI: 10.1590/0102-311xen016423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 05/24/2024] Open
Abstract
This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.
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Shi J, Li Y, Xing C, Peng P, Shi H, Ding H, Zheng P, Ning G, Feng S. Urapidil, compared to nitroglycerin, has better clinical safety in the treatment of hypertensive patients with acute heart failure: a meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 13:161-172. [PMID: 30643384 PMCID: PMC6312052 DOI: 10.2147/dddt.s185972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives The application of urapidil for treating hypertensive patients with acute heart failure in the emergency department remains controversial. Our objective was to organize the relevant articles and assess the clinical indexes between urapidil and nitroglycerin. Materials and methods PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure were searched for randomized studies that compared urapidil treatment with nitroglycerin treatment for hypertensive patients with acute heart failure. The risk ratio, with 95% CI, was calculated by using a corresponding effects model, according to the value of I2. Results Seven randomized controlled trials were identified, in order to compare the clinical indexes. On comparing the clinical indexes, the urapidil group was found to be better than the nitroglycerin group in regard to left ventricular ejection fraction, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, left ventricular end-diastolic volume, cardiac index, ALT, AST and health complications (P<0.05), but the indexes of creatinine were worse in the urapidil group. Furthermore, the two methods of treatment were comparable in diastolic blood pressure, left ventricular end-systolic volume, left ventricular end-systolic dimension, heart rate, fasting plasma glucose and total cholesterol levels (P>0.05). Conclusion Based on the current evidence, urapidil treatment had better clinical safety features than the traditional pharmaceutical treatment with nitroglycerin. For those indicators with a small amount of data, a greater number of randomized, high-quality controlled trials should be conducted in order to further verify the findings, which could give researchers a more comprehensive evaluation of urapidil treatment.
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Affiliation(s)
- Jiaxiao Shi
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Yulin Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Cong Xing
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Peng Peng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Hongyu Shi
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Han Ding
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Pengyuan Zheng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Guangzhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, PR China, ; .,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Heping District, Tianjin 300052, PR China, ;
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