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Rivasi G, Coscarelli A, Capacci M, Ceolin L, Turrin G, Tortù V, D'Andria MF, Testa GD, Ungar A. Tolerability of Antihypertensive Medications: The Influence of Age. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00639-z. [PMID: 38658522 DOI: 10.1007/s40292-024-00639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Despite high prevalence of hypertension, few studies have analysed the adverse effects (AEs) of antihypertensive medications, especially in older patients. AIM To investigate the prevalence and associated factors of antihypertensive-related AEs, focusing on the influence of age on treatment tolerability. METHODS We retrospectively investigated antihypertensive-related AEs in patients evaluated at the Hypertension Clinic of Careggi Hospital, Florence, Italy, between January 2017 and July 2020. Multivariable regression models were generated to analyse variables associated with AEs in the overall sample and in participants ≥75 years. RESULTS Among 622 subjects (mean age 64.8 years, 51.4% female), the most frequently reported AEs were calcium-channel blockers (CCB)-related ankle swelling (26.8%) and ACEi-induced cough (15.1%). Ankle swelling was more common in older patients (35.7% vs 22.3%, p = 0.001; odds ratio [OR] 1.94, 95%CI 1.289-2.912) and was independently associated with Body Mass Index (BMI, adjOR 1.073) and angiotensin-receptor antagonists (adjOR 1.864). The association with BMI was confirmed in older patients (adjOR 1.134). ACEi-induced cough showed similar prevalence in younger and older patients (13.9% vs 15.6%, p = 0.634), being independently associated with female sex (adjOR 2.118), gastroesophageal reflux disease (GERD, adjOR 2.488) and SNRI therapy (adjOR 8.114). The association with GERD was confirmed in older patients (adjOR 3.238). CONCLUSIONS CCB-related ankle swelling and ACEi-induced cough represent the most common antihypertensive-related AEs, also at old age. Older patients showed a two-fold increased risk of ankle swelling, that was also independently associated with BMI. ACEi-induced cough had similar prevalence at younger and old ages, being independently associated with GERD.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
| | - Antonio Coscarelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Capacci
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Ludovica Ceolin
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Giada Turrin
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Virginia Tortù
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Maria Flora D'Andria
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Referral Centre for Hypertension in Older Adults, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
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Rivasi G, D'Andria MF, Bulgaresi M, Sgrilli F, Casini G, Falzone D, Turrin G, Tortù V, Giordano A, Mossello E, Ungar A. Screening for cognitive impairment in older adults with hypertension: the HYPER-COG study. J Hum Hypertens 2023; 37:1000-1006. [PMID: 36932153 DOI: 10.1038/s41371-023-00817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
Hypertension is a major risk factor for dementia. Yet, the most suitable cognitive screening test for hypertensive patients has yet to be identified. This study investigated cognitive impairment in hypertensive older adults and compared the discriminative ability of the most widely used cognitive screening tests. The study involved hypertensive patients aged 65+ without prior diagnosis of cognitive impairment, from the Hypertension Clinic of Careggi Hospital, Florence, Italy. Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), MiniCog and Clock Drawing Test (CDT) were administered, using a comprehensive neuropsychological assessment as gold standard. The ROC curve analysis and the paired chi-square test were used to compare the discriminative ability, sensitivity and specificity for cognitive impairment of the different screening instruments. Cognitive impairment was diagnosed in 37% of 94 participants (mean age 76, 55% female), mainly involving attention and executive functions. The MoCA (AUC = 0.746), the MMSE (AUC = 0.689) and the MiniCog (AUC = 0.684) showed similar ability in detecting cognitive impairment, while the CDT had a poorer discriminative capacity (AUC = 0.535). The sensitivity of MoCA (80%) and of MMSE/MiniCog combination (74%) was higher in comparison with MiniCog alone (49%, p = 0.007 and 0.004, respectively), while MiniCog achieved the highest specificity (88%, p < 0.001 vs all). Cognitive impairment was detected in more than one-third of hypertensive older adults without prior diagnosis of dementia. MoCA, MMSE and MiniCog showed similar discriminative ability for cognitive impairment, with MoCa and MMSE showing greater sensitivity and MiniCog the highest specificity.
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Affiliation(s)
- Giulia Rivasi
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Maria Flora D'Andria
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Federica Sgrilli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Giulia Casini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Daniele Falzone
- Occupational Medicine Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giada Turrin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Virginia Tortù
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Antonella Giordano
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Enrico Mossello
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Ungar
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Rivasi G, Mossello E, Turrin G, D'Andria MF, Tortù V, Ceolin L, Coscarelli A, Fedeli A, Rafanelli M, Brignole M, Ungar A. Hypotensive episodes revealed by ambulatory blood pressure monitoring in nursing home residents. J Am Geriatr Soc 2021; 70:902-905. [PMID: 34800288 PMCID: PMC9299255 DOI: 10.1111/jgs.17570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Giulia Rivasi
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Enrico Mossello
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Giada Turrin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Maria Flora D'Andria
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Virginia Tortù
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Ludovica Ceolin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Antonio Coscarelli
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Angela Fedeli
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Martina Rafanelli
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Michele Brignole
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiovascular Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Andrea Ungar
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
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Iacomelli I, Giordano A, Rivasi G, Rafanelli M, Tortù V, Cartei A, Rostagno C, Di Bari M, Marchionni N, Mossello E, Ungar A. Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C? Eur J Intern Med 2021; 84:74-79. [PMID: 32718879 DOI: 10.1016/j.ejim.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 01/24/2023]
Abstract
AIM Muscle mass is frequently reduced in older patients experiencing injurious falls and may further reduce during hospitalization for bone fracture. In these patients, renal function may be overestimated, because it is usually calculated using serum creatinine, which is strictly related to muscle mass. We evaluated if creatinine levels change during hospitalization in older patients with fracture. We also assessed the role of cystatin C as a more appropriate marker of renal function, comparing estimated glomerular filtration rate (eGFR) according to different formulas based on creatinine and/or cystatin C levels. METHODS Patients aged 65+ years, consecutively hospitalized for fracture, were enrolled in a prospective cohort study. Creatinine and cystatin C levels were measured at baseline and in the post-operative period; eGFR was calculated using six equations based on creatinine and/or cystatin C. RESULTS 425 patients were enrolled (mean age 84 years, mean creatinine 0.97 mg/dL, mean cystatin C 1.53 mg/L). Creatinine levels significantly decreased after surgery (p<0.001), while cystatin C remained stable. According to creatinine-based formulas, eGFR was < 60 mL/min/1.73 m2 in 29-30% at baseline and only in 17% participants in the post-operative period. Conversely, according to equations including cystatin C, eGFR was < 60 mL/min/1.73 m2 in half to three-quarters of the sample at all assessments. CONCLUSIONS In older fractured patients, creatinine levels decline during hospital stay and may possibly overestimate renal function, whereas cystatin C remains stable. Whether cystatin C is a more reliable marker of renal function in this specific population should be further investigated.
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Affiliation(s)
- Iacopo Iacomelli
- Internal Medicine, "S. Maria alla Gruccia" Valdarno Hospital, Azienda USL Toscana Sud-Est, Montevarchi (AR), Italy.
| | - Antonella Giordano
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Giulia Rivasi
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Martina Rafanelli
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Virginia Tortù
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Alessandro Cartei
- Internal and post-surgery Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Carlo Rostagno
- Internal and post-surgery Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Mauro Di Bari
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Niccolò Marchionni
- Department of Cardio-thoracic-vascular Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Enrico Mossello
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Andrea Ungar
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Mossello E, Rivasi G, Tortù V, Giordano A, Iacomelli I, Cavallini MC, Rafanelli M, Ceccofiglio A, Cartei A, Rostagno C, Di Bari M, Ungar A. Renal function and delirium in older fracture patients: different information from different formulas? Eur J Intern Med 2020; 71:70-75. [PMID: 31711727 DOI: 10.1016/j.ejim.2019.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/24/2019] [Accepted: 10/17/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES the association between renal function and delirium has not been investigated in older fracture patients. Creatinine is frequently low in these subjects, which may influence the association between delirium and renal function as estimated with creatinine-based formulas. Cystatin C could be a more reliable filtration marker in these patients. AIM to confirm the association between renal function and delirium in older fracture patients comparing creatinine- and cystatin-based estimated glomerular filtration rate (eGFR) METHODS: patients aged 65+ requiring surgery for traumatic bone fractures were included. Six equations were used to calculate eGFR, based on serum creatinine and/or cystatin C obtained within 24 h of admission: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPIcr, CKD-EPIcys, CKD-EPIcr-cys) and Berlin Initiative Study equations (BIS-1, BIS-2). Delirium was identified with a chart-based method. RESULTS 571 patients (mean age 83) were enrolled. Delirium occurred in the 34% and was associated with a lower eGFR regardless of the equation used. In a multivariable model, the association between moderate renal impairment (eGFR 30-60 ml/min/1.73 m2) and delirium remained significant in patients aged 75-84 and only when estimated with cystatin-based or BIS-1 equations. Only dementia was significantly associated with delirium in subjects 85+. CONCLUSIONS in older fracture patients, moderate renal impairment was independently associated with delirium only among subjects aged 75-84, when eGFR was estimated with cystatin-based or BIS 1 equations, and not with the most commonly used equations (MDRD, CKD-EPIcr).
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Affiliation(s)
- Enrico Mossello
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Giulia Rivasi
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy
| | - Virginia Tortù
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy
| | - Antonella Giordano
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Iacopo Iacomelli
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy
| | - Maria Chiara Cavallini
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Martina Rafanelli
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Alice Ceccofiglio
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Alessandro Cartei
- Internal and post-surgery Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Carlo Rostagno
- Internal and post-surgery Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Mauro Di Bari
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Andrea Ungar
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
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