• Sebastiano Cicco, Marco D Abbondanza, Marco Proietti, Vincenzo Zaccone, Chiara Pes, Federica Caradio, Massimo Mattioli, Salvatore Piano, Alberto Maria Marra, Alessandro Nobili, Pier Mannuccio Mannucci, Antonello Pietrangelo, Giorgio Sesti, Elena Buzzetti, Andrea Salzano, Antonio Cimellaro, and Giovani Internisti Società Italiana di Medicina Interna (GIS-SIMI) and of the REPOSI Investigators.
• Department of Biomedical Sciences and Human Oncology (DIMO), Internal Medicine Unit "Guido Baccelli" and Unit of Arterial Hypertension "Anna Maria Pirrelli", University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy.
• Eur. J. Clin. Invest. 2023 Apr 1; 53 (4): e13931e13931.

BackgroundHypertension management in older patients represents a challenge, particularly when hospitalized.ObjectiveThe objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients.MethodsA total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptor-blocker (ARB) with a calcium-channel-blocker (CCB) and/or a thiazide diuretic; if >80 years old, an ACE-I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all-cause death, cardiovascular (CV) hospitalization/death, CV death, non-CV death, evaluated according to the presence of MT at discharge.ResultsHypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all-cause death, all-cause death/hospitalization, CV death, CV death/hospitalization and non-CV death.ConclusionsGuidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in antihypertensive treatment still occur in a significant proportion of older hospitalized patients.© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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