McCracken R, et al. – This research aspired to elucidate the nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension. The potential correlations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy were evaluated in this study. It was noted that overtreated diabetes and hypertension were prevalent in nursing home patients, and the presence of polypharmacy was related to a more aggressive treatment of these risk factors. Advanced studies were required to reduce overtreatment of hypertension and diabetes. This would enable the complete comprehension of the potential links between polypharmacy and potential of harms of condition–specific overtreatment.

Methods

• The design of this trial was a cross-sectional study.
• It was performed at 6 nursing homes in British Columbia, Canada.
• The candidates included 214 patients residing in one of the selected facilities during data collection period.
• The primary measure was as follows: Polypharmacy was defined as ≥9 regular medications.
• Overtreatment of diabetes was defined as being prescribed at least one hypoglycaemic medication and a glycosylated haemoglobin (HbA1c) ≤7.5%.
• Overtreatment of hypertension required being prescribed at least one hypertension medication with a systolic blood pressure ≤128 mm Hg.
• Polypharmacy prescribing, independent of overtreatment, was estimated by subtracting condition-specific medications from total medications prescribed.

Results

• 214 patients were examined, 104 (48%) of whom were prescribed ≥9 medications.
• All patients were very frail.
• Patients with polypharmacy exhibited the likelihood of having a diagnosis of hypertension (p=0.04) or congestive heart failure (p=0.003) and were less likely to present with a diagnosis of dementia (p=0.03).
• Patients with overtreated hypertension were more likely to also experience polypharmacy (Relative Risk (RR))1.77 (1.07 to 2.96), p=0.027).
• Patients with overtreated diabetes were given more non-diabetic medications than those with a higher HbA1c (11.0±3.7vs 7.2±3.1, p=0.01).