gms | German Medical Science

24th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

30.11. - 01.12.2017, Erfurt

Combined use of medicines affecting the renin-angiotensin system: dual RAS blockade in German nursing home residents

Meeting Abstract

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 24. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Erfurt, 30.11.-01.12.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17gaa95

doi: 10.3205/17gaa95, urn:nbn:de:0183-17gaa951

Published: December 5, 2017

© 2017 Dörks et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Background: In 2012, the European Medicines Agency reviewed the safety of dual renin-angiotensin system (RAS) blockade through the combined use of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) or aliskiren, based on concerns about the lack of benefit and potentially increased risks of hyperkalemia, hypotension and renal failure.

Residents of nursing homes are typically characterised by a high prevalence of chronic diseases and they often receive polypharmacy including RAS acting agents. Therefore, the aim of our study was to characterise prescribing patterns of RAS acting drugs in German nursing home residents with a special emphasis on dual RAS blockade.

Materials and Methods: Using data from a large statutory health insurance fund with about six million insurants, this study was based on new nursing home residents from 2010 to 2014 aged 65 years or older. Baseline data were analysed using descriptive statistics. Nursing home residents with no prescription of a RAS acting drug in the year before the first RAS prescription after nursing home entry were defined as incident users. Prevalence of dual RAS blockade was examined in residents with at least one RAS acting drug prescription and defined as prescriptions of at least two different RAS acting drug classes (i) on the same day and (ii) within a 14 day period, respectively.

Results: Overall, the study population comprised 64.567 patients (50.7% of all new nursing home residents) treated with at least one RAS acting agent. Mean age was 86.0 ± 6.8 years and about three quarters of the study population were female (77.1%). Common diagnoses were hypertension (85.2%), diabetes mellitus (34.2%) and chronic kidney disease (14.1%). Based on the first prescription during their nursing home stay, most residents were treated with ACEIs (77.8%), followed by ARBs (21.6%). Aliskiren was prescribed to 0.2% of residents and 0.4% received two or three different RAS acting drug classes on that day. Incident use of RAS acting drugs was found in 9,794 nursing home residents. After nursing home entry, most prevalent users maintained on their RAS acting drug class (96.8%). Defined as concomitant prescriptions on the same day, prevalence of dual RAS blockade declined from 9.6 (95%CI 7.8-11.8) in 2010 to 4.7 (95%CI 4.0-5.4) per 1,000 residents in 2014. Using the 14 day period, prevalence decreased from 15.1 (95%CI 12.7-17.7) to 10.1 (95%CI 9.1-11.1) per 1,000 residents, respectively.

Conclusion: Prescribing of RAS acting agents is common in nursing home residents. Prevalence of dual RAS blockade declined substantially over the study period. Further studies are needed to assess the impact of potentially inappropriate prescribing on individual health outcomes in this vulnerable population.