Is dose titration required for antihypertensive agents in geriatric diabetic patients?

Rajeshwari Shastry, Prabha M.R. Adhikari, Sheetal D. Ullal, Mukta N. Chowta, Sahana D. Acharya

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl). Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients’ demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups. Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57% and ramipril required 18.36% dose reduction in geriatrics compared to non-geriatrics. Conclusion: A 20% dosage reduction is needed for ACEIs in the elderly.

Original languageEnglish
Pages (from-to)510-513
Number of pages4
JournalAsian Journal of Pharmaceutical and Clinical Research
Volume11
Issue number12
DOIs
Publication statusPublished - 01-12-2018

Fingerprint

Geriatrics
Antihypertensive Agents
Creatinine
Hypertension
Angiotensin-Converting Enzyme Inhibitors
Enalapril
Angiotensin Receptor Antagonists
Ramipril
Blood Pressure
Amlodipine
Hydrochlorothiazide
Atenolol
Losartan
Calcium Channel Blockers
Calcium Channels
Pharmaceutical Preparations
Type 2 Diabetes Mellitus
Observational Studies
Demography
Serum

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmaceutical Science
  • Pharmacology (medical)

Cite this

@article{9ee8fa6077344f608654903d8b953c41,
title = "Is dose titration required for antihypertensive agents in geriatric diabetic patients?",
abstract = "Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl). Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients’ demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups. Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57{\%} and ramipril required 18.36{\%} dose reduction in geriatrics compared to non-geriatrics. Conclusion: A 20{\%} dosage reduction is needed for ACEIs in the elderly.",
author = "Rajeshwari Shastry and Adhikari, {Prabha M.R.} and Ullal, {Sheetal D.} and Chowta, {Mukta N.} and Acharya, {Sahana D.}",
year = "2018",
month = "12",
day = "1",
doi = "10.22159/ajpcr.2018.v11i12.29181",
language = "English",
volume = "11",
pages = "510--513",
journal = "Asian Journal of Pharmaceutical and Clinical Research",
issn = "0974-2441",
publisher = "Innovare Academics Sciences Pvt. Ltd",
number = "12",

}

Is dose titration required for antihypertensive agents in geriatric diabetic patients? / Shastry, Rajeshwari; Adhikari, Prabha M.R.; Ullal, Sheetal D.; Chowta, Mukta N.; Acharya, Sahana D.

In: Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, No. 12, 01.12.2018, p. 510-513.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is dose titration required for antihypertensive agents in geriatric diabetic patients?

AU - Shastry, Rajeshwari

AU - Adhikari, Prabha M.R.

AU - Ullal, Sheetal D.

AU - Chowta, Mukta N.

AU - Acharya, Sahana D.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl). Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients’ demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups. Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57% and ramipril required 18.36% dose reduction in geriatrics compared to non-geriatrics. Conclusion: A 20% dosage reduction is needed for ACEIs in the elderly.

AB - Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl). Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients’ demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups. Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57% and ramipril required 18.36% dose reduction in geriatrics compared to non-geriatrics. Conclusion: A 20% dosage reduction is needed for ACEIs in the elderly.

UR - http://www.scopus.com/inward/record.url?scp=85058333978&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058333978&partnerID=8YFLogxK

U2 - 10.22159/ajpcr.2018.v11i12.29181

DO - 10.22159/ajpcr.2018.v11i12.29181

M3 - Article

VL - 11

SP - 510

EP - 513

JO - Asian Journal of Pharmaceutical and Clinical Research

JF - Asian Journal of Pharmaceutical and Clinical Research

SN - 0974-2441

IS - 12

ER -