Qualitative analysis of hypertension medical treatment

Qualitative analysis of hypertension medical treatment in the elderly population living in a nursing home in France 

INTRODUCTION 

C. JOYAU1, F. DELAMARRE-DAMIER3, G. VEYRAC1, P. JOLLIET1,2 
(1) Department of Clinical Pharmacology, Institut of Biology, Nantes, France,
(2) EA4275 «Biostatistics, Pharmacoepidemiology and Subjective Health Measures», Medicine University, Nantes
(3) Coordinating physician of nursing home, France and Hospital Practioner, Cholet Hospital, France 


Several studies have shown that hypertension treatment of the elderly patient over 80 years of age could reduce cardiovascular events such as stroke mortality, overall mortality and heart failure [1]. It is therefore appropriate to treat hypertension in patients older than 80 years. In this population, the objective is a systolic blood pressure (SBP) less than 150 mmHg , since a decrease of 20 to 30 mmHg compared with initial SBP is already a significant benefit in terms of morbidity in patients with SBP greater than 180 mmHg [2]. In elderly hypertensive patients, a decrease of SBP below 140 mmHg has not clearly shown a benefit [3]. 

According to experts, antihypertensive therapy in the elderly should not include more than 3 antihypertensive drugs. In case of high blood pressure (>20/10 mmHg above the recommended therapeutic target), dual therapy may be prescribed at the beginning, including thiazide diuretic. The first-line treatment in elderly patients with systolic hypertension is a thiazide diuretic at low doses or dihydropyridine calcium channel blocker [2]. The objective of this study is to describe hypertension medical treatment in nursing home. 


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NEURODEM study – Assessment of the iatrogenic alert indicator for nursing home patients with Alzheimer or Alzheimer-like disease

NEURODEM study – Assessment of the iatrogenic alert indicator for nursing home patients with Alzheimer or Alzheimer-like disease

INTRODUCTION

Samir Henni, MD, MBA,ac Anne Sonnic, MD,bc Florence Delamarre Damier, MD, MBA, CMDc, Gwenaelle Feinard, Pharm D,cd
Gwenaelle Veyrac, MD,ce Laure de Decker, MD, PhD,b Gilles Berrut, MD, PhD,bc Sylvie Piessard, Pharm D, PhD,cf

a - Hospital Center Aimé Jallot and Francis Robert, 160 Rue du Verger, 44150 Ancenis,France ;
b - Clinical Gerontology Department, Bellier Hospital, University Hospital, 41 rue Curie, 44046 Nantes cedex 1, France ;
c - AGREE, 8 Brairon, 44690 Château Thebaud, France ;
d - Sevre and Loire Hospital, 44430 Le Loroux-Bottereau, France ;
e - Clinical Pharmacology Department, Institute of Biology, University hospital, Nantes, France ;
f - Sèvre and Loire Hospital, 44120 Vertou, France and Faculty of Pharmacy, Nantes University, 9, rue Bias BP53508, 44035 Nantes Cedex 1, Nantes, France

Neuropsychiatric symptoms (NPSs) occur in about 80% of patients during the evolution of Alzheimer’s disease and other related dementia and are often one of the reasons these people are placed in nursing homes.1 Neuroleptic drugs are often prescribed for these NPSs although it is known that their efficacy is low (10-20 %).2,3 In France, in 2008, about 3 % of the elderly general population received neuroleptics compared with 18 % of those with Alzheimer’s disease and up to 27 % of those who lived in nursing homes.5 In the setting of a national plan for Alzheimer’s disease, in 2010 the French National Health Authority (in French: Haute Autorité de Santé; HAS) implemented a program called ‘Alert and Control of the Iatrogenic risk of Neuroleptics in Alzheimer’s Disease’ (AIM-Alzheimer) to reduce the misuse of neuroleptics in patients with Alzheimer’s disease.4

 

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