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

doi:10.22159/ajpcr.2018.v11i12.29181

Authors

Rajeshwari Shastry Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India. http://orcid.org/0000-0003-2414-0457
Prabha M R Adhikari Department of Medicine, Yenepoya Medical College, Deralakatte, Yenepoya University, India.
Sheetal D Ullal Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Mukta N. Chowta Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Sahana D Acharya Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i12.29181

Keywords:

Geriatrics, Hypertension, Non-geriatrics, Diabetes

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 â‰¥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 Cockcroftâ€“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 (8.40Â±7.26 vs. 5.46Â±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14Â±13.51 vs. 133.38Â±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.

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Author Biography

Rajeshwari Shastry, Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Associate Professor, Department of Pharmacology, Kasturba Medical College, Light House Hill Road, Mangalore - 575001, Manipal Academy of Higher Education.

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